Qaid updates, ROP

      Alhamdulillah qaid is gaining weight and doing well... kalau sebelum ni dia kat A4 (tingkat paling atas), 3 hari lepas iaitu on aidiladha he was transferred to A3 (tingkat 2)...the ward for those prem awaiting weight gain...
          First time mama masuk kat A3 tu, tgk ramainya lah prem babies and other problematic babies kat situ...riuh rendah dan meriah dengan suara babies..sblm ni kat A4 sunyi sikit, dan lebih tenang...dan nurses pun mungkin punya lebih byk masa for every babies.. Harap2 kat A3 yang ramai babies ni, my qaid will be fed according to time la.. (tadi pergi dan tgk dia, rasanya masa minum yg sepatutnya pukul 11 dah jadi 12.30pm..kesian dia kelaparan...tp nak salahkan nurse tu pun tak boleh, sbb mmg ramai baby kat cubical tu..ada 7 more babies there), and she was alone entertaining all of them.. cubical lain nampaknya lebih ramai nurses, maybe sbb lbh byk problemnya...
   Oh qaid, mama tak sabar tunggu qaid 1.4kg, so that mama can stay in the hospital and feed u on my own..(breastfeed, insyaAllah)..so cepatlah besar sayang...(Hari ni berat Qaid 1.335kg).
Tadi first time jugak qaid dipakaikan baju (baju hospital), kaler pink la pulak..tp baju alone dah cukup utk cover all his body, no need to wear pants, and this baju actually supaya he can maintain his body temperature dan cepat membesar..Cian anak mama ni, mama lum beli baju utk qaid lagi, cadangnya nak ke jusco this monday, insyaAllah...
Kalau ikutkan qaid is suppossed to be 35 weeks skrg ni, (kalau masih dalam perut mama)..masa kakak qaisara dulu pun mama tunggu 36 week baru gi beli baju dan semua barang keperluan...

Tadi jugak mama diberitahu Qaid need to be assessed by senior ophthalmologist because of his ROP getting worse..ya Allah sedihnya mama dengar..harap2 problem mata qaid tak progress lebih teruk.. Rabu ni is his appointment to see the eye doctor..
 Walaupun mama memang tahu this is the complication of prematurity since he was born at 24 weeks, of course mama masih berharap there will be a miracle later..May Allah kabulkan doa mama agar qaid terselamat dari segala komplikasi..insyaAllah
...

Retinopathy of prematurity (ROP), previously known as retrolental fibroplasia (RLF), is an eyeretinal blood vessels which may result in scarring and retinal detachment. ROP can be mild and may resolve spontaneously, but may lead to blindness in serious cases. As such, all preterm babies are at risk for ROP, and very low birth weight is an additional risk factor. Both oxygen toxicity and relative hypoxia can contribute to the development of ROP. disease that affects prematurely born babies. It is thought to be caused by disorganized growth of

Pathophysiology

Normally, maturation of the retina proceeds in-utero and at term, the mature infant has fully vascularized retina. However, in preterm infants, the retina is often not fully vascularized. ROP occurs when the development of the retinal vasculature is arrested and then proceeds abnormally. The key disease element is fibrovascular proliferation. This is growth of abnormal new vessels that may regress, but frequently progresses. Associated with the growth of these new vessels is fibrous tissue (scar tissue) that may contract to cause retinal detachment. Multiple factors can determine whether the disease progresses, including overall health, birth weight, the stage of ROP at initial diagnosis, and the presence or absence of "plus disease". Supplemental oxygen exposure, while a risk factor, is nothypoxia-related systemic complications. the main risk factor for development of this disease. Restricting supplemental oxygen use does not necessarily reduce the rate of ROP, and may raise the risk of other

Patients with ROP are at greater risk for strabismus, glaucoma, cataracts and myopia later in life, and should be examined yearly to help prevent and treat these conditions.

International classification of retinopathy of prematurity (ICROP)

The system used for describing the findings of active ROP is entitled The International Classification of Retinopathy of Prematurity (ICROP).^[1] ICROP uses a number of parameters to describe the disease. They are location of the disease into zones (1, 2, and 3), the circumferential extent of the disease based on the clock hours (1-12), the severity of the disease (stage 1-5) and the presence or absence of "Plus Disease". Each aspect of the classification has a technical definition. This classification was used for the major clinical trials. It has been revised in 2005^[2]

Zones of the retina in ROP

The zones are centered on the optic nerve. Zone 1 is the posterior zone of the retina, defined as the circle with a radius extending from the optic nerve to double the distance to the macula. Zone 2 is an annulus with the inner border defined by zone 1 and the outer border defined by the radius defined as the distance from the optic nerve to the nasal ora serrata. Zone 3 is the residual temporal crescent of the retina.

The circumferential extent of the disease is described in segments as if the top of the eye were 12 on the face of a clock. For example one might report that there is stage 1 disease for 3 clock hours from 4 to 7 o'clock. (The extent is a bit less important since the treatment indications from the Early Treatment for ROP^[3])

The Stages describe the ophthalmoscopic findings at the junction between the vascularized and avascular retina.

• Stage 1 is a faint demarcation line.
• Stage 2 is an elevated ridge.
• Stage 3 is extraretinal fibrovascular tissue.
• Stage 4 is sub-total retinal detachment.
• Stage 5 is total retinal detachment.

In addition, Plus disease may be present at any stage. It describes a significant level of vascular dilation and tortuosity observed at the posterior retinal vessels. This reflects the increase of blood flow through the retina.

Prognosis

Stages 1 and 2 do not lead to blindness. However, they can progress to the more severe stages. Threshold disease is defined as disease that has a 50% likelihood of progressing to retinal detachment. Threshold disease is considered to be present when stage 3 ROP is present in either zone I or zone II, with at least 5 continuous or 8 total clock hours of disease, and the presence of plus^[4] Progression to stage 4 (partial retinal detachment), or to stage 5 (total retinal detachment), will result in substantial or total loss of vision for the infant. disease.

Treatment

• Peripheral retinal ablation is the mainstay of ROP treatment. The destruction of the avascular retina is performed with a solid state laser photocoagulation device, as these are easily portable to the operating room or neonatal ICU. Cryotherapy, an earlier technique in which regional retinal destruction was done using a probe to freeze the desired areas, has also been evaluated in multi-center clinical trials as an effective modality for prevention and treatment of ROP. However, cryotherapy is no longer preferred for routine avascular retinal ablation in premature babies, due to the side effects of inflammation and lid swelling.
• Scleral buckling and/or vitrectomy surgery may be considered for severe ROP (stage 4 and 5) for eyes that progress to retinal detachment. Few centers in the world specialize in this surgery, because of its attendant surgical risks and generally poor outcomes.
• Intravitreal injection of bevacizumab (Avastin) has been reported as a supportive measure in aggressive posterior retinopathy of prematurity

Mama masih berharap sgt the disease will not progress further...Ya Allah...help..pleasee..


Thanks to encik wikipedia:
http://en.wikipedia.org/wiki/Retinopathy_of_prematurity