Anemia of Prematurity - Portal Neonatal

FOLLOW-UP Section 7 of 10
Further Inpatient Care:
• Base follow-up examinations on previous examination results. The more immature the
retinal vasculature or the more serious the disease, the shorter the follow-up interval must
be to enable the detection of disease. These examinations allow the physician to offer
treatment if threshold disease develops in the eye.
• After surgical intervention, an ophthalmologist should perform an examination to determine
if additional surgery is indicated.
• Patients who are medically monitored must undergo examinations until the retinal
vasculature is mature. Ensuring appropriate follow-up for infants is critical if they are
discharged from the nursery before retinal vascular maturity is attained.
Further Outpatient Care:
• Patients require yearly ophthalmologic follow-up evaluations. More frequent evaluation may
be necessary, depending on the severity of the disease.
• The long-term outcome for infants with ROP continues to be problematic. Patients with ROP
are at significant risk for myopia. In addition, strabismus, amblyopia, and late retinal
detachment continue to be problems for these infants. Long-term follow-up findings from the
CRYO-ROP cooperative group indicate that refractive errors in eyes with mild ROP are
associated with the same risk of myopia as that in eyes without ROP. In patients with
moderate-to-severe ROP, the prevalence of severe myopia is increased. As previously
stated, laser surgery offers some advantage over cryotherapy in treating zone 1 disease.
Deterrence/Prevention:
• The only known deterrent measure is to prevent preterm birth. The more mature a neonate
is at birth, the less likely ROP is to occur.
• Recent studies regarding the effects of antenatal corticosteroids on ROP revealed that this
treatment has a protective effect against severe ROP.
Complications:
• Late complications include myopia, amblyopia, strabismus, nystagmus, retinal breaks, and
retinal detachment.
• Follow-up by an ophthalmologist is required on a long-term basis.
MISCELLANEOUS Section 8 of 10
Medical/Legal Pitfalls:
• The timing of examination and follow-up are important factors in the diagnosis and treatment
ROP. If a patient misses an examination, it should be rescheduled as soon as possible.
• Ensuring that parents are aware of the significance of ROP and appropriate follow-up is also
important.
• Because of the risk of rush retinopathy, premature infants with immature retina and/or
progressive ROP who come from a high-risk social environment should stay in the hospital
and undergo retinal examinations every 1-2 weeks.