الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Despite the marked improvement in the neonatal care, monitoring and
treatment~ still Retinopathy of Prematurity (ROP) continues to be an
important problem in premature infants. The exact etiology of ROP is still
unknown but a large number of factors are suggested to be involved in the
development of the disease. This study presents the effect of human milk
feedings on the incidence ofROP among VLBW infants, also to determine if
the presence of candidemia in infants is associated with an increased
incidence and severity of ROP after controlling for some possible risk
factors. All preterm infants were admitted to Neonatal intensive care unit of
Benha children hospital from the period of March 2003 to March 2006, and
exposed to mechanical ventilation during their stay inside the NICU due to
respiratory distress
Our study included 120 preterm neonates; only 60 cases who
continued up to 28 days and underwent indirect opthalmoscopic
examination. Others either died (48 cases) or discharged without eye
examination (12 cases).
The results showed that the incidence ofROP was found in 35 out of
60 preterm infants (the incidence was 58%), and 25 out of 60 were normal
(42%)
The incidence of the various stages ofROP was as follows:
13 cases showed stage I (21.50/0)of all studied cases
11 cases showed stage II (18.3%) of all studied cases
8 cases showed stage III (18.3%) of all studied cases
2 cases showed stage IV (3.4%) of all studied cases
1 cases showed stage I (1.6%) of all studied cases
SWlUlltlry and Conclusion .
According to the distribution of Rap severity, there were 25 cases
without any Rap changes (420/0)and 25 cases show less than threshold
disease (42%) of total cases, 6 (six) cases show prethreshold (100/0)and only
4 (four cases show threshold disease (6%).
Progression of Rap occurred in four cases out of 35 Rap positive
cases of ROP (110/0).Of the four progressive cases, three were treated by
cryotherapy for threshold ROP while the other one developed retinal
detachment and vitrectomy was done, while spontaneous regression
occurred in the remaining 31 positive cases (890/0).
Infants were divided according to type of feedings introduced during
their stay inside the NlCU into three groups.
Group I (EBM): It include 20 preterm neonates < 34 weeks of gestation,
VLBW < 1500 gram, exposed to M.V., and all of them were
exclusively breast fed. Nine of them showed ROP changes (45%),
which were as following:
Three were stage I (15%)
Three were stage II (150/0)
Three were stage III (150/0)
Group n (PBM): Include 20 preterm neonates < 34 weeks of gestation,
VLBW < 1500 grams, exposed to M.V., and were partially breast
fed and partially formula fed. Eleven showed rep changes (55%),
which were as following;
Five were stage I (25%)
Four were stage II (200/0)
Two were stage III (10%)
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SU1IfIIICJrf and Conclusion
200
fed infants, through our study design and statistical adjustment. Our findings
suggest a protective effect of human milk feedings against ROP after
controlling for potential confounding variables. Clinical interventions to
reduce the development ofROP have been limited because many identified
risk factors for ROP are difficult to alter in clinical practice. The ability to
limit supplemental oxygen administration is necessarily constrained by the
need to safeguard the life and neurological status of the VLBW infant. We
have identified a potential preventive measure, the provision of maternally
expressed human milk, which may reduce the development of ROP without
accompanying adverse effects.
There was a significant difference between the incidence and severity
of ROP in relation to the low birth weight, as the highest incidence and most
severe affected cases were found among infants with birth weight < 1250
gm.
There was a significant association between the incidence and severity
of ROP and lower gestational age as the highest incidence and most severe
affected cases occurred with the lowest gestational age.
Univariate analysis of the association between ROP changes and
many risk factors was preformed and revealed that : Neonatal variables
showing a significant difference (p value < 0.05) were found in; birth
weight, gestational age, duration of mechanical ventilation (M.V.), total
oxygen supplementation duration, M.V. settings (Fi02, 02 index, MAP, PIP,
Rate, Tl ), some neonatal complications and procedures (H.F., lasix
administration, blood transfusion, exchange transfusion, sepsis, NEC, TPN,
HIE, convulsions, barbiturates administration). This was in relation to both
incidence and severity of ROP development. Maternal variables showing a
significant difference (p value < 0.05) were found in; antenatal hemorrhage,
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SJUfflfUJry and Conclusion
201
PROM, pre-eclampsia. positive consanguinity, primygravida and mothers
younger than 27 years.
There was no significant association between the presence of ROP
changes and PEEP of mechanical ventilation settings, also there was no
significant association between the presence of ROP changes and multiple
births, mode of delivery and cardiac mothers.
Multiple logistic regression analysis of the significant risk factors for
the development of ROP showed that birth weight, gestational age, duration
of mechanical ventilation, and 02 index were found to be highly significant.
Type of feeding, neonatal sepsis, H.F., HIE, NEC, blood tranSfusion and
exchange tranSfusion..were found to be significant. So this reflects the fact
that ROP occurs principally in a sick preterm.
In conclusion..retinopathy of prematurity is a disease of developing
retinal blood vessels. Immaturity (low gestational age and low birth weight)
is the greatest risk: for ROP development due to ocular immaturity and
increased risk of neonatal complications specially prolonged requirement for
supplementary oxygen treatment and aided respiration, Neonatal sepsis, H.F.
and repeated blood transfusions.