A male neonate is born prematurely to 22-year-old primigravida and experiences severe respiratory distress. The distress resolves with treatment, and by two weeks of age, the patient has adequate respiratory function. Ophthalmoscopy later shows abnormal retinal vascularization that extends into the vitreous. The retinal findings in this patient are most likely related to:

Question

A male neonate is born prematurely to 22-year-old primigravida and experiences severe respiratory distress.  The distress resolves with treatment, and by two weeks of age, the patient has adequate respiratory function.  Ophthalmoscopy later shows abnormal retinal vascularization that extends into the vitreous.  The retinal findings in this patient are most likely related to:

Quizplus · Accepted Answer

Respiratory distress in a premature neonate is most commonly due to pulmonary surfactant deficiency resulting in hyaline membrane disease. Treatment involves administration of supplemental oxygen at high concentrations, nasal continuous positive airway pressure, and/or mechanical ventilation with intratracheal surfactant. One potential adverse effect of oxygen therapy is retinal damage. Temporary local hyperoxia in the retina is thought to induce changes that cause up-regulation of proangiogenic factors such as vascular endothelial growth factor (VEGF) upon return to room air ventilation. Retinal vessel proliferation (neovascularization) and possible retinal detachment with blindness may result. This complication of neonatal respiratory distress syndrome is referred to as retinopathy of prematurity or retrolental fibroplasia. (Choice A) Terbutaline is a β-mimetic tocolytic drug used to delay labor and delivery by suppressing uterine contractions. Use of terbutaline has been linked to an increased risk of neonatal intraventricular hemorrhage, hypoglycemia, hypocalcemia, and ileus. (Choice B) Corticosteroids may be administered to pregnant women entering premature labor in an effort to induce surfactant production by the fetal lungs. Maternal steroid treatment in the prenatal period does not cause neonatal retinal neovascularization. (Choice C) Neonatal antibiotic treatment does not cause retinal neovascularization. (Choice E) Complications of surfactant treatment may include transient hypoxia and hypotension, blockage of an endotracheal tube, and pulmonary hemorrhage. Retinal neovascularization is not a known complication. Educational Objective: Use of concentrated oxygen therapy for neonatal respiratory distress syndrome may be complicated by retinopathy of prematurity. This abnormal retinal neovascularization is a major cause of blindness in developed nations.

A Male Neonate Is Born Prematurely to 22-Year-Old Primigravida and Experiences