Abstract 1290 Poster Session IV, Tuesday, 5/4 (poster 252)
Hyoxia has been shown to be a common precursor to retinal neovascularization (Folkman J., Klagsbrun, M.: Science 1987;235:442-446). Vascular endothelial growth factor (VEGF) is an endothelial cell-specific mitogen that is stimulated by hypoxia. We hypothesized that increased VEGF secondary to hypoxia during premature birth adaptation may contribute to recanalization or neovascularization resulting in the development of systemic to pulmonary collaterals (SPC) and severe retinopathy of prematurity (ROP). Therefore, we prospectively evaluated the incidence of Stage III or greater ROP among infants with SPC. Between 1994 and 1996, we prospectively evaluated 133 VLBW infants with serial echocardiograms and color flow Doppler studies for the presence of SPC. SPC were identified in 88 of the 133 infants (66%). Infants with SPC (mean BW 1011g; mean GA 28 weeks) required prolonged mechanical ventilation and had longer length of stay as compared to infants without SPC (p=0.05 and 0.02 respectively.) However, oxygen requirement at 36 weeks post conceptional age was not significantly different between the 2 groups (p=0.34). Stage III or greater ROP was present in 21/88 (23.8%) infants with SPC as compared to only 5/45 (11.1%) infants without SPC. Our results show greater than 2 fold increase in the incidence of severe ROP among VLBW infants with systemic to pulmonary collaterals. We speculate that similar mechanisms may be operative in the development of these two conditions among VLBW infants. Attempts to treat severe retinopathy of prematurity with supplemental oxygen may also positively impact the development of systemic to pulmonary collaterals in premature infants.
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Ramanathan, R., Siassi, B., Sardesai, S. et al. Is There a Link between the Development of Systemic to Pulmonary Collaterals and Stage III or Greater Retinopathy of Prematurity in Very Low Birth Weight Infants? A Prospective Evaluation. Pediatr Res 45, 220 (1999) doi:10.1203/00006450-199904020-01307