The Effect of Serum Igf-1,Igfbp-3 And Erythrocyte Transfusıons on Development of Mıld Retınopathy of Prematurıty (original) (raw)
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The role of blood transfusions and iron intake on retinopathy of prematurity
Early Human Development, 2001
The role of blood transfusions and iron intake in the pathogenesis or retinopathy Ž . Ž . of prematurity ROP is controversial. Aim: To evaluate the influence of packed red cell PRC transfusions and iron intake on ROP incidence. Study design: Prospective observational study. Subjects: Forty-five preterm infants with birthweight -1250 g were studied. After ophthalmo-Ž . logical study, they were divided into group A n s 24 that included newborns without ROP, and Ž . group B n s 21 that included newborns with ROP. Results: Logistic regression analysis Ž . demonstrated that gestational age OR 0.61; 95% C.I. 0.41-0.90 , transfusion volume during the Ž . Ž first week OR 1.16; 95% C.I. 1.03-1.3 and during the first 2 months of life OR 2.93; 95% C.I.
Blood Transfusion: A Risk Factor in Retinopathy of Prematurity
Bangladesh Journal of Child Health, 2012
Background: Retinopathy of prematurity (ROP) is a retinal vascular disorder of preterm neonates resulting in visual impairement. Along with prematurity, very low birth weight and hyperoxia, role of blood transfusions in the occurrence of ROP has been strongly emphasized. Objective: To determine the relationship of timing and volume of blood transfusion and other factors with the development of ROP in preterm very low birth weight (VLBW) newborn infants. Methods: This was a prospective observational study. It was done among the premature (<34 weeks) VLBW neonates admitted to SCABU and ICU of Dhaka Shishu Hospital. Neonates who fulfilled the inclusion criteria were followed up daily to record certain clinical factors and effect of blood transfusions. Among 93 discharged neonates subjected to have ophthalmological screening, 58 (62%) completed the examinations. After ophthalmological study, they were divided into "Normal group" (n=35) that included newborns without ROP, and "Abnormal group" (n=23) that included newborns with ROP. Comparative analysis of recorded clinical factors was done between the two groups. Results: Blood transfusion during the first week of life (p=.002, OR 1.15; C.I. 1.01-1.32) and cumulative volume of transfused blood (ml/kg) (p=.002, OR2.8, CI: 1.65-4.41) were significantly associated with the development of ROP. All neonates with ROP have got one or more transfusions (p=.003; OR 2.11 95% CI.012-.676). Univariate analysis demonstrated that VLBW (p=.03; OR .93;, duration of oxygen inhalation (p=.001; OR 28; OR3.36;) has significant relationship with ROP.
Early fresh-frozen plasma transfusion decreases the risk of retinopathy of prematurity
Transfusion, 2014
Insulin-like growth factor 1 (IGF-1) and IGF-binding protein-3 (IGFBP-3) play a main role in the pathogenesis of retinopathy of prematurity (ROP). Fresh-frozen plasma (FFP) from adult donors may be an actual source of IGF-1 and IGFBP-3 because it contains higher concentrations. The objective was to evaluate whether FFP transfusions can decrease the occurrence of ROP in a cohort of preterm infants. We retrospectively analyzed data from 218 infants with gestational age of less than 29 weeks who either received FFP or did not and correlated this procedure to the development of any grade of ROP. Logistic regression analysis demonstrated that two or more transfusions of FFP was effective in decreasing the risk of development of any grade of ROP (relative risk, 0.46; 95% confidence interval, 0.23-0.93). Other factors that affected the risk of ROP were gestational age, birthweight, antenatal steroid treatment, FiO2 of at least 0.40, mechanical ventilation, and sepsis. We found that two or...
Neonatology
Introduction: Thrombocytopenia has been identified as an independent risk factor for retinopathy of prematurity (ROP), although underlying mechanisms are unknown. In this study, the association of platelet count and serum platelet-derived factors with ROP was investigated. Methods: Data for 78 infants born at gestational age (GA) <28 weeks were included. Infants were classified as having no/mild ROP or severe ROP. Serum levels of vascular endothelial growth factor A, platelet-derived growth factor BB, and brain-derived neurotrophic factor were measured in serum samples collected from birth until postmenstrual age (PMA) 40 weeks. Platelet counts were obtained from samples taken for clinical indication. Results: Postnatal platelet counts and serum concentrations of the 3 growth factors followed the same postnatal pattern, with lower levels in infants developing severe ROP at PMA 32 and 36 weeks (p < 0.05–0.001). With adjustment for GA, low platelet counts and low serum concentra...
rhIGF-1/rhIGFBP-3 in Preterm Infants: A Phase 2 Randomized Controlled Trial
The Journal of Pediatrics
and on behalf of the study team* Objective To investigate recombinant human insulin-like growth factor 1 complexed with its binding protein (rhIGF-1/rhIGFBP-3) for the prevention of retinopathy of prematurity (ROP) and other complications of prematurity among extremely preterm infants. Study design This phase 2 trial was conducted from September 2014 to March 2016. Infants born at a gestational age of 23 0/7 weeks to 27 6/7 weeks were randomly allocated to rhIGF-1/rhIGFBP-3 (250 µg/kg/ 24 hours, continuous intravenous infusion from <24 hours of birth to postmenstrual age 29 6/7 weeks) or standard neonatal care, with follow-up to a postmenstrual age of 40 4/7 weeks. Target exposure was ≥70% IGF-1 measurements within 28-109 µg/L and ≥70% intended therapy duration. The primary endpoint was maximum severity of ROP. Secondary endpoints included time to discharge from neonatal care, bronchopulmonary dysplasia, intraventricular hemorrhage, and growth measures. Results Overall, 61 infants were allocated to rhIGF-1/rhIGFBP-3, 60 to standard care (full analysis set); 24 of 61 treated infants achieved target exposure (evaluable set). rhIGF-1/rhIGFBP-3 did not decrease ROP severity or ROP occurrence. There was, however, a 53% decrease in severe bronchopulmonary dysplasia in the full analysis set (21.3% treated vs 44.9% standard care), and an 89% decrease in the evaluable set (4.8% vs 44.9%; P = .04 and P = .02, respectively) for severity distribution between groups. There was also a nonsignificant trend toward decrease in grades 3-4 intraventricular hemorrhage in the full analysis set (13.1% vs 23.3%) and in the evaluable set (8.3% vs 23.3%). Fatal serious adverse events were reported in 19.7% of treated infants (12/61) and 11.7% of control infants (7/60). No effect was observed on time to discharge from neonatal care/growth measures. Conclusions rhIGF-1/rhIGFBP-3 did not affect development of ROP, but decreased the occurrence of severe bronchopulmonary dysplasia, with a nonsignificant decrease in grades 3-4 intraventricular hemorrhage.
Prematür retinopatisinin tanısı ve lazer tedavisine cevabın takibinde VEGF ve IGF-1’in değeri
Cukurova Medical Journal
Öz Purpose: Early recognition of the retinopathy of prematurity (ROP), timely and appropriate treatment will contribute to the developmental process of the infant and increase the quality of life by preventing vision loss. We here by aimed to figure out the value of the blood levels of vascular endothelial growth factor (VEGF) and insulin-like growth factor-1 (IGF-1) in infants with severe ROP requiring laser therapy. Materials and Methods: Very low birth weight infants (VLBW, ≤1500 g and gestational age ≤32 weeks) were included in the study. Blood samples for the evaluation of markers were obtained from the cord at birth for all preterms and at the same postpartum corrected age (34 weeks) for ROP and control group. Results: The mean serum VEGF level was 185.6 ± 88.1 pg/mL in the control group and 590.2 ± 97.4 pg/mL before laser treatment in the ROP group. It was decreased to 83.7 ± 25.4 pg/mL at 4 day after laser treatment in the ROP group). No significant difference was existed between the values of IGF-1 before and after laser treatment in infants with severe ROP. Conclusion: Serum VEGF and IGF-1 levels may be suggested as a sensitive marker of severe ROP. Additionally, the decrease in serum levels of VEGF after laser therapy can be used as an indicator for the efficacy of laser treatment. Amaç: Prematüre retinopatisinin (ROP) erken tanınması, zamanında ve uygun tedavisi, bebeğin gelişim sürecine katkıda bulunacak ve görme kaybını önleyerek yaşam kalitesini artıracaktır. Biz burada lazer tedavisi gerektiren şiddetli ROP olan bebeklerde vasküler endotelyal büyüme faktörü (VEGF) ve insülin benzeri büyüme faktörü-1'in (IGF-1) kan düzeylerinin değerini belirlemeyi amaçladık. Gereç ve Yöntem: Çok düşük doğum ağırlıklı bebekler (ÇDDA, ≤1500 g ve gestasyonel yaş ≤32 hafta) çalışmaya alındı. ROP ve kontrol grubu için tüm pretermler için doğumdan itibaren ve aynı doğum sonrası düzeltilmiş yaşta (34 hafta) belirteçlerin değerlendirilmesi için kan örnekleri alındı. Bulgular: Kontrol grubunda ortalama serum VEGF düzeyi 185,6 ± 88,1 pg / mL ve ROP grubunda lazer tedavisi öncesi 590,2 ± 97,4 pg / mL idi. ROP grubunda lazer tedavisinden 4 gün sonra 83,7 ± 25,4 pg / mL'ye düştü Şiddetli ROP'lu bebeklerde lazer tedavisi öncesi ve sonrasında IGF-1 değerleri arasında anlamlı fark yoktu. Sonuç: Serum VEGF ve IGF-1 seviyeleri, şiddetli ROP'un duyarlı bir belirteçleri olarak önerilebilir. Ek olarak, lazer tedavisinden sonra VEGF'nin serum seviyelerindeki azalma, lazer tedavisinin etkinliği için bir gösterge olarak kullanılabilir.
Pediatric Research, 2013
Background: In preterm infants, low levels of insulin-like growth factor-I (IGF-I) and IGF binding protein 3 (IGFBP-3) are associated with impaired brain growth and retinopathy of prematurity (ROP). Treatment with IGF-I/IGFBP-3 may be beneficial for brain development and may decrease the prevalence of ROP. Methods: In a phase II pharmacokinetics and safety study, five infants (three girls) with a median (range) gestational age (Ga) of 26 wk + 6 d (26 wk + 0 d to 27 wk + 2 d) and birth weight of 990 (900-1,212) g received continuous intravenous infusion of recombinant human (rh)IGF-I/rhIGFBP-3. Treatment was initiated during the first postnatal day and continued for a median (range) duration of 168 (47-168) h in dosages between 21 and 111 µg/kg/24 h. results: Treatment with rhIGF-I/rhIGFBP-3 was associated with higher serum IGF-I and IGFBP-3 concentrations (P < 0.001) than model-predicted endogenous levels. Of 74 IGF-I samples measured during study drug infusion, 37 (50%) were within the target range, 4 (5%) were above, and 33 (45%) were below. The predicted dose of rhIGF-I/rhIGFBP-3 required to establish circulating levels of IGF-I within the intrauterine range in a 1,000 g infant was 75-100 µg/kg/24 h. No hypoglycemia or other adverse effects were recorded. conclusion: In this study, continuous intravenous infusion of rhIGF-I/rhIGFBP-3 was effective in increasing serum concentrations of IGF-I and IGFBP-3, and was found to be safe.
Background. Extremely low gestational age neonates (ELGAN, i.e., neonates born before 28 weeks of gestation), are at high risk of developing retinopathy of prematurity (ROP), with potential long-life visual impairment. Due to concomitant anemia, ELGANs need repeated red blood cell (RBC) transfusions. These produce a progressive replacement of fetal hemoglobin (HbF) by adult hemoglobin (HbA). Furthermore, a close association exists between low levels of HbF and severe ROP, suggesting that a perturbation of the HbF-mediated oxygen release may derange retinal angiogenesis and promote ROP. Methods/design. BORN (umBilical blOod to tRansfuse preterm Neonates) is a multicenter double-blinded randomized controlled trial in ELGANs, to assess the effect of allogeneic cord blood RBC transfusions (CB-RBCs) on severe ROP development. Recruitment, consent and randomization take place at 10 Neonatology Intensive Care Units (NICUs) of 8 Italian tertiary Hospitals. ELGANs with gestational age at bir...