00:01
Our first topic here is a newborn and I don't mean any newborn, not a term,
we have a newborn who's a preemie, so maybe 27 weeks.
00:10
36 weeks is approximately normal, correct?
27 weeks I've given you.
00:14
Now, the only choice that you have at this point is to then place a beautiful newborn, right, in the NICU,
in other words in neonatal ICU.
00:25
The only choice that you have now in this 27-week-old preemie will then be to provide oxygen.
00:34
Do you think this newborn that is a preemie at 27 weeks is able to handle all these oxygen
that you and I as an adult should be having?
I don't know.
00:47
Beause there's every possibility that the oxygen may then become a free radical
or reactive oxygen species or reactive oxygen intermediate, whatever you wanna call it.
00:56
And that free radical, the oxygen therapy, may then cause damage to retina prematurely
in which this newborn then goes into blindness.
01:08
Unfortunate.
01:09
This is then called retinopathy of prematurity, ROP.
01:15
Hopefully, the ROP newborn doesn't go into RIP.
01:20
A lot of times that happens.
01:22
You have no choice.
01:24
You have no choice.
01:25
You have to give oxygen and then in pathology we've talked about how the first 27 weeks
there's every possibility that the newborn may not have surfactant.
01:34
So in addition there might be neonatal respiratory distress syndrome, correct?
In addition, there might be necrotizing enterocolitis, there might bronchodysplasia.
01:42
So put the entire patient holistically.
01:46
Make sure that you know what's going on when there's free radical damage in the newborn.
01:50
A bunch of complications that you must know.
01:52
Now with retinopathy of prematurity, when you're destroying this retina,
the retina then becomes extremely, extremely desperate for blood vessels.
02:03
So you're gonna have VEGF-mediated which stands for vascular endothelial growth factor.
02:10
And you're gonna have these little blood vessels that are now being formed.
02:13
It's called neovascularization.
02:16
The neovascularization is occurring in this premature newborn.
02:22
It could be extremely dangerous so therefore,
part of the therapy could be the anti-VEGF therapy as well.
02:29
Keep that in mind, that's important.
02:31
Vascular proliferation in retinopathy of prematurity.
02:34
You'll have grey avascular retinal border.
02:38
It's a newborn who is premature so therefore, the retinal border is not receiving enough blood.
02:44
This part could actually be normal because it's a preemie.
02:49
The neovascularization, as you see here in the schematic, is going to be dilated, tortuous blood vessels.
02:58
What does that represent?
Neovascularization.
03:01
What happened here?
A premature child, maybe 27 weeks,
receiving oxygen and in the process may then cause free radical damage.
03:11
You'll have a dragged optic disc pulled by the preretinal membrane as I talked about
and recurrent retinal bleeding in neovascularization.
03:23
As all what you're seeing here depicted in the retina.
03:25
This is of a newborn.
03:28
Can you see all those little blood vessels?
That's a lot of neovascularization.
03:32
All that neovascularization might then be pulling on the retinal layer
and in the process you're worried about retinal detachment.
03:41
And also this neovascularization or the new blood vessels,
they're extremely, extremely weak and vulnerable to rupture.
03:50
And if that happens you'll have retinal bleeding.
03:52
You see the dark areas in the'it pulls the blood here a little bit'in your fundoscopic examination.
03:59
All parts of retinopathy of prematurity.