Medical treatment includes abdominal decompression, bowel rest, broad-spectrum antibiotics, and parenteral nutrition. Surgery is reserved for neonates with intestinal perforation or deteriorating clinical or biochemical status. Possible surgical procedures include drain placement, exploratory laparotomy with resection of diseased bowel, or enterostomy with creation of a stoma (Neu, 2010).
By 1950, this condition, formerly known as retrolental ibroplasia, became the largest single cause of blindness in this country. Mter the discovery that the disease resulted from hyperoxemia, its frequency declined but began to rise again with the increasing survival rates of extremely pre term newborns.
Normally, the fetal retina vascularizes centrifugally from the optic nerve starting at approximately the fourth month and continues until shortly after birth. During vascularization, excessive oxygen induces severe retinal vasoconstriction with endothelial damage and vessel obliteration. his is followed by subsequent aberrant neovascularization, in which the new vessels penetrate the retina and extend into the vitreous. Here, they are prone to leak proteins or burst with subsequent hemorrhage. Adhesions can form to detach the retina. Vascular endothelial growth factor (VEGF) plays an important role in normal angiogenesis and is up regulated during retinopathy of prematurity (ROP) development (Sharma, 2017). his understanding has opened new avenues of treatment with anti-VEGF therapies.
Precise levels of hyperoxemia that can be sustained without causing ROP are unknown. Mter birth, there is a "relative" hyperoxia compared with in utero oxygen content, even in newborns not exposed to higher inspired oxygen concentrations. To better understand the oxygen saturation threshold necessary to minimize ROP without raising rates of other adverse outcomes, the Neonatal Research Network performed a randomized trial of oxygenation in 1316 neonates born between 24 and 27 weeks' gestation (SUPPORT Study Group, 2010a). he two target ranges of oxygen saturation were 85 to 89 percent in one arm and 91 to 95 percent in the other arm. hese targets were both commonly employed in neonatal intensive care units. Death before discharge occurred signiicantly more frequently in the lower-oxygen saturation group-20 versus 16 percent. However, severe ROP among survivors developed signiicantly less often in the lower-oxygen saturation group 8.6 versus 17.9 percent.
roanatomical sequelae in preterm newborns compared with those at term (Chap. 33, p. 621). In preterm neonates, cerebral orrhage, cerebellar hemorrhage, periventricular hemorrhagic infarction, cystic periventricular leukomalacia, and difuse white matter injury. All of these are strongly associated with adverse neurodevelopmental outcomes (Kwon, 2014).
Cranial sonography remains the preferred approach for events. It is readily available and reliable for detecting common abnormalities and monitoring brain growth. Because cystic inju ries may take 2 to 5 weeks to evolve, serial scans are obtained dur ing this time. In those whose findings are transient and resolve in the neonatal period, prognosis is improved compared with infants whose lesions remain and evolve. At the same time, how ever, between 4 and 10 percent of prematurely born children may develop cerebral palsy (CP) in the absence of lesions. Put another way, 90 to 96 percent of preterm newborns with CP have cerebral lesions that are detectable using cranial sonography.