435 - Nailfold Microvasculature as a Non-Invasive Predictor of Retinopathy of Prematurity

Poster Number: 435
Publication Number: 435.137

Daniel J. York, Northwestern University, Chicago, IL, United States; Hawke Yoon, Ann & Robert H. Lurie Children's Hospital of Chicago/Feinberg School of Medicine Northwestern University, Chicago, IL, United States; Isabelle De Plaen, Northwestern University The Feinberg School of Medicinn, Chicago, IL, United States

Background: Abnormal microvascular development contributes to the pathogenesis of several diseases of prematurity such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC) and retinopathy of prematurity (ROP). Recently, machine learning image analysis has allowed for detailed assessment of microvasculature. However, there is currently no well-established non-invasive method for assessing systemic microvascular development in premature infants. Nailfold capillaroscopy is a non-invasive technique useful in adult and pediatric rheumatology which is not currently used in premature in neonates to assess capillary development.

Objective: We hypothesize that in premature infants, nailfold capillaroscopy can non-invasively detect vascular maldevelopment and predict ROP prior to the clinical manifestation of disease.

Design/Methods: In an initial longitudinal cohort of 39 VLBW infants < 32 weeks gestation, nailfold capillary network images taken 2 weeks apart during the first month of life were analyzed for makers of vascular density: vascular length density (VLD) and vessel branch point density (VBPD). We analyzed images using a convolutional neural network (CNN) approach and a previously validated microvascular quantification platform (REAVER Vascular Analysis). The primary outcome was subsequent development of moderate to severe ROP based on a consensus ROP severity scale.

Results: VLD was significantly higher among ROP patients vs no/mild ROP at both time points: first study time-point: 15,351(µm/ mm2) [95%CI: 14,751-15,951] vs 13,055(µm/ mm2) [11,427-14,684], second study time-point: 12,264(µm/ mm2) [10,723- 13805] vs 9,757(µm/ mm2) [8142-11373] respectively; p< 0.05. VLD significantly decreased over the first month of life among all patients: mean of 13,890µm/ mm2 [12,771-15,009] in infants with < 15 days of post-menstrual age vs. mean of 10,669 µm/ mm2 [9,455-11,883] in infants with ≥15 days of post-menstrual age (p < 0.0001). VBPD was also significantly higher at both time-points comparing ROP and no/mild ROP patients: first study time-point: 200.7 branches/mm2 [130-182] vs 156.5 branches/mm2 [130-183], second study time-points: 143.1 branches/mm2 [111-174] vs 99.2 [75-124], p < 0.05.Conclusion(s): Nailfold capillaroscopy in VLBW infants may help identify neonates at highest risk for morbidities, such as ROP, that result in part from dysregulated angiogenesis long before the disease manifests clinically. Moreover, peripheral microvascular changes may parallel those seen in other organs in the aging premature neonate and may be a potential tool to monitor long-term microvascular health.
Neonatal Microvascular Assessment as a Biomarker of MorbidityYORK_CV_092121.pdf