Abstract
Retrolental fibroplasia has traditionally required the combination of prematurity and exposure to high ambient oxygen concentrations. However, cases of RLF in stillborn infants as well as an infant near term never given supplimental oxygen have been reported. Two recent papers have emphasized an increased incidence of RLF in populations of preterm infants with respiratory distress syndrome who received exchange transfusions.
This report describes two infants near term who received exchange transfusions for hyperbilirubinemia and subsequently developed severe RLF in the absence of environmental hyperoxia and clinical respiratory distress. The case histories, clinical courses and retinal photographs will be presented. The possible etiologic role of the shift of oxygen-hemoglobin affinity caused by transfusions with adult erythrocytes with increased oxygen availability to the retinal vessels and tissues will be discussed.
The medical and legal implications of our cases and the recent reports are many. For one, the levels of oxygen considered safe for neonates receiving exchange transfusion nay have to be re-evaluated. Secondly, serial thorough ophthalmologic evaluations in any neonate receiving adult erythrocytes by exchange transfusion or multiple transfusion replacement is crucial. Finally, the traditional relationship of hyperoxia and RLF must be expanded and re-evaluated to include other parameters like the hematologic status of the neonate and should include appreciation that this may be a phenomenon independent of environmental hyperoxia.
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Adamkin, D., Cook, L., Shott, R. et al. NONHYPEROXIC RETROLENTAL FIBROPLASIA. Pediatr Res 11, 530 (1977). https://doi.org/10.1203/00006450-197704000-00963
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DOI: https://doi.org/10.1203/00006450-197704000-00963