Guidelines for retinopathy of prematurity further explained | MedNet

The previous guidelines for Retinopathy of Prematurity (ROP) date back to 2012. In recent years, the old guidelines have been analysed, analyzed and changed in the revised version that has been published 10 years later in November 2023. Stefan de Geus, a member of the orientation work group led by Prof. Nicoline Schalij, explains the most important changes.

“The old guidelines were much more detailed,” said Stefan de Geus, who is also an ophthalmologist and vitreoretinal surgeon at Radboudumc and the Retina Eyescan Operation Center. “Not everything was worked out, some advice was dated and new insights and treatment options were added. A survey by the neonatology patient association Care4neo called for more attention to the provision of better information regarding the screening test.

ROP screening is known as an examination due to giving an eye dilator and looking into the child’s eyes with a camera or lamp. “We knew that from practice, but it was very different in what the parents were told and how this happened.” Around 100 responses to the survey showed that more than 40% had not received written information. about the research. That was amazing. Sometimes it was given in speech that it was a ‘bad’ study and it was better not to be present.” That is why the guidelines now recommend the provision of written and verbal information.Guidelines are also given to comfort parents and children, so that the burden is as low as possible and not rushed. the screenings effectively.

The criteria for screening have changed in the new guidelines. Where gestational age was less than 30 weeks previously or birth weight below 1250 grams was a reason for screening for ROP, both conditions must now be met: less than 30 weeks and less than 1250 grams. “As a result, 25% fewer displays are required. We save a large number of children from doing research without losing children who need treatment,” said De Geus about the safety of the change. Inclusion criteria for risk factors for ROP and the screening schedule for controls have remained unchanged.

Anti-VEGF injection

Laser coagulation is the old standard for ROP treatment. The new guidelines add anti-VEGF injections as an alternative and complementary treatment option.

“By giving anti-VEGF in selected cases and at the right time, the balance of growth factors in the eye can be restored, which quickly inhibits the pathological activity of ROP and increases the chance that the blood vessels grow longer and sometimes.” Anti-VEGF has an effect within a week and the effect lasts 4 to 14 weeks. “During that time, regular checks should be done for recurrent ROP activity and the degree of blood vessel dilation. In many cases even later (so-called canceled) need laser treatment.”

“With anti-VEGF, the chance of complete spontaneous growth is present, but small when treating ROP in zone 1. The problem of new blood vessel formation often returns later, which means that laser treatment is still necessary as a definitive solution,” De Geus gives as an argument for the different approach in zones 1 and 2. that significant time will be saved by treating well simple and short. If the new formation returns at, for example, 40 weeks of age, the area you need for laser has become smaller and the child can handle anesthesia better.”

Oxygen saturation

Another addition not previously included in the guidelines is recommendations for the oxygen saturation target when ventilating a premature infant with pre-plus-ROP. “In children with pre-plus-ROP, it can now be considered to set the oxygen saturation level for a higher period to > 95% in consultation with the neonatologist,” said De Geus. “Higher oxygen tension can delay the growth of pathological blood vessels in the eye and the development of ROP, sometimes delaying or even preventing treatment. ”

Accordingly, advice has also been introduced to monitor the hemoglobin (Hb) level in the blood in case of active ROP. “This advice was inspired by case reports of a severe course of ROP in the setting of a low hemoglobin level,” says De Geus. “Many premature babies suffer in the early stages after birth because their hemoglobin breaks down quickly,” he explains. “But after 32 weeks reach age, Hb is often determined and lower Hb is accepted as well. However, the course of ROP can accelerate at low Hb, since oxygen carrying capacity is limited that it would be useful to increase the Hb through movement, so that the oxygen balance can be restored. still receiving respiratory support) based on standard pediatrician guidelines for premature infants. “The important thing is that doctors are aware that Hb can affect the course of the disease.”