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Retinopathy of PrematurityFer-ROPNCT05133999

Iron and Retinopathy of Prematurity (ROP)

An observational study of Retinopathy of Prematurity, run by Assistance Publique - Hôpitaux de Paris at 3 sites in France.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

The purpose of this study is to determine whether increased transferrin saturation in plasma (that reflects iron overload and/or low transferrin) is an independent risk factor for ROP development and severity. Preterm infants born at <31 week's post-menstrual age (PMA) or ≤1250g of birth weight will be included. Read more about this study

Who is it for?
Ages 24 to 31 weeks
Conditions the study is for
Retinopathy of Prematurity
What is being tested?
Plasma determination of iron, transferrin and ferritin and Fundus Examination by wide field digital imaging camera (PanocamTM camera)
How many people
175 participants
Where
3 sitesFrance
Study dates
28 Apr 2022to 18 Aug 2025
Phase
Observational
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 24 to 31 weeks
  • All sexes
  • No healthy volunteers
  • Child

Study population: Preterm infants born at <31 weeks' PMA or ≤1250 g of birth weight

Who may be able to join

  • All infants born at <31 week's post-menstrual age (PMA) or ≤1250g of birthweight
  • Admitted at two neonatology departments (level III) from birth
  • With non-opposition consent of two parents

Who cannot join

  • Congenital malformation
  • Life-threatening condition (not expected to survive more than a few days)
  • Absence of health care protection.

Trial locations and contacts

3 sites in 1 country.

France3 sites
  • Pediatrics and neonatal intensive care department - Cochin hospital - Port Royal Maternity

    Paris, 75014

  • Ophtalmology department _ Necker Enfants Malades Hospital

    Paris, 75015

  • Pediatrics and noenatal intensive care department - Necker-Enfants Malades Hospital

    Paris, 75015

Other trials in France

About this study

Official title: Iron, Transferrin and Retinopathy of Prematurity (ROP): Towards New Pathophysiological Mechanisms.

The purpose of this study is to determine whether increased transferrin saturation in plasma (that reflects iron overload and/or low transferrin) is an independent risk factor for ROP development and severity.

Preterm infants born at <31 week's post-menstrual age (PMA) or ≤1250g of birth weight will be included. Iron parameters in plasma will be measured during the first month of life. Retinopathy of prematurity (ROP) will be screened as currently recommended. The relationship between plasma iron parameters and ROP development and/or severity will be established.

Read the detailed description

The incidence of ROP, the main cause of vision impairment in children, is increasing parallel to the recent changes in practices targeting higher oxygen saturation in preterm babies in many countries following the publication of five trials that showed higher rates of death with lower oxygen saturations. The main risk factor for ROP development is oxygen excess. Oxygen contributes to the formation of reactive oxygen species and to lipid peroxidation which leads to vasoconstriction, vascular cytotoxicity, and arrest of vascular development causing ischemia of retinal neurons, thereby promoting the development of ROP.

90% of extremely low birth weight infants need red blood cell transfusions (RBCT) due to their immature erythropoiesis, frequent blood sampling and small circulating blood volume. RBCT are a major source of iron overload and ferritin plasma levels may remain elevated for several weeks after transfusions. It has been shown that blood transfusion is a risk factor of ROP in preterm infants. However, whether this relationship is mediated by an increased iron load remains controversial.

Only two studies, conducted before the 2000s, identified plasma iron overload as a risk factor for ROP. These studies with a limited number of patients, showed contradictory results, failing to draw a conclusion.

Excess iron worsens oxidative stress. Iron catalyzes the Fenton reaction which leads to the formation of reactive oxygen species. In addition a transferrin deficiency (the main iron chelator) has been suggested in premature infants. The oxidative stress observed in ROP could therefore be the consequence not only of oxygen therapy but also of iron overload.

The main objective of this study is to determine whether increased transferrin saturation in plasma (that reflects iron overload and/or low transferrin) is an independent risk factor for ROP development and severity.

The secondary aims/objectives are :

  • Determine whether low transferrin level in plasma is an independent risk factor for ROP development and severity.
  • Determine whether iron parameters imbalance in plasma are a risk factor for other comorbidities in Preterm infants i.e.:
  • 1) sepsis
  • 2) severe bronchopulmonary dysplasia
  • 3) necrotizing enterocolitis (stage 2 or 3)
  • 4) cystic periventricular leukomalacia
  • 5) grade III or IV intraventricular haemorrhage

Study duration will be 29 months, with an inclusion period of 24 months and a last visit for ROP evaluation at 45 week's post-menstrual age (PMA).

A total of 175 patients should be included: 35 with ROP and 140 without ROP.

Being tested
Plasma determination of iron, transferrin and ferritin, Fundus Examination by wide field digital imaging camera (PanocamTM camera)
Keywords
retinopathy, prematurity, ROP, Iron and transferrin, Preterm infants
Medical subject headings
Retinopathy of Prematurity, Retinal Diseases, Premature Birth

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Plasma determination of iron, transferrin and ferritinBiological

    Iron, transferrin and ferritin levels in plasma

  • Fundus Examination by wide field digital imaging camera (PanocamTM camera)Other

    ROP screening using wide field digital retinal imaging according to current recommendations.

Study groups in NCT05133999
Study groupRoleWhat they receive
Preterm infantsinfants born at <31 week's post-menstrual age (PMA) or ≤1250g of birth weight
Receives: Biological: Plasma determination of iron, transferrin and ferritin; Other: Fundus Examination by wide field digital imaging camera (PanocamTM camera)

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. ROP screening

    Presence of ROP development (any stage / any zone in at least one eye) during follow-up.

    Measured: From 31 to 45 weeks' post menstrual age (PMA) [= (term + 4 weeks of life)].

  2. Levels of transferrin saturation in plasma at 1 week of life

    Blood dosage

    Measured: at 1 week of life

Secondary outcomes (7)
  1. Levels of iron

    Blood dosage, in µmol/l

    Measured: at birth, 2, 3, and 4 weeks of life

  2. Levels of transferrin

    Blood dosage, in g/l

    Measured: at birth, 2, 3, and 4 weeks of life

  3. Levels of ferritin

    Blood dosage, in µg/l

    Measured: at birth, 2, 3, and 4 weeks of life

  4. ROP's highest stage

    according to International Classification of Retinopathy of Prematury (ICROP3 classification)

    Measured: during follow-up about 5 months, up to 45 weeks' PMA

  5. Need of treatment for ROP

    Laser, anti-VEGF injections, surgery

    Measured: during follow-up about 5 months, up to 45 weeks' PMA

  6. Number of each intervention

    Number of each intervention if a treatment was needed

    Measured: during follow-up about 5 months, up to 45 weeks' PMA

  7. Death or presence of severe co-morbidities in preterm infant

    death or presence of monitoring :

    1. severe bronchopulmonary dysplasia or 2) necrotizing enterocolitis (stage 2 or 3), or 3) cavitary periventricular leucomalacia or 4) intraventricular haemorrhage (grade III or IV).

    Measured: At 36 weeks' PMA

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted24 Nov 2021
  2. Study start28 Apr 2022
  3. Primary completion18 Aug 2025
  4. Study completion18 Aug 2025

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Observational
Observational model
Cohort
Time perspective
Prospective
Enrolment
175 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05133999
Sponsor's protocol ID
APHP211233
Other IDs
2021-A02182
Acronym
Fer-ROP
Status last verified
Oct 2025
First submitted
2 Nov 2021
Last updated
20 Nov 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
No

Publications

  • de Verdier K, Ulla E, Lofgren S, Fernell E. Children with blindness - major causes, developmental outcomes and implications for habilitation and educational support: a two-decade, Swedish population-based study. Acta Ophthalmol. 2018 May;96(3):295-300. doi: 10.1111/aos.13631. Epub 2017 Nov 23.

    PubMed 29168313
  • Manley BJ, Kuschel CA, Elder JE, Doyle LW, Davis PG. Higher Rates of Retinopathy of Prematurity after Increasing Oxygen Saturation Targets for Very Preterm Infants: Experience in a Single Center. J Pediatr. 2016 Jan;168:242-244. doi: 10.1016/j.jpeds.2015.10.005. Epub 2015 Nov 6.

    PubMed 26548746
  • BOOST II United Kingdom Collaborative Group; BOOST II Australia Collaborative Group; BOOST II New Zealand Collaborative Group; Stenson BJ, Tarnow-Mordi WO, Darlow BA, Simes J, Juszczak E, Askie L, Battin M, Bowler U, Broadbent R, Cairns P, Davis PG, Deshpande S, Donoghoe M, Doyle L, Fleck BW, Ghadge A, Hague W, Halliday HL, Hewson M, King A, Kirby A, Marlow N, Meyer M, Morley C, Simmer K, Tin W, Wardle SP, Brocklehurst P. Oxygen saturation and outcomes in preterm infants. N Engl J Med. 2013 May 30;368(22):2094-104. doi: 10.1056/NEJMoa1302298. Epub 2013 May 5.

    PubMed 23642047
  • Sapieha P, Joyal JS, Rivera JC, Kermorvant-Duchemin E, Sennlaub F, Hardy P, Lachapelle P, Chemtob S. Retinopathy of prematurity: understanding ischemic retinal vasculopathies at an extreme of life. J Clin Invest. 2010 Sep;120(9):3022-32. doi: 10.1172/JCI42142. Epub 2010 Sep 1.

    PubMed 20811158
  • Howarth C, Banerjee J, Aladangady N. Red Blood Cell Transfusion in Preterm Infants: Current Evidence and Controversies. Neonatology. 2018;114(1):7-16. doi: 10.1159/000486584. Epub 2018 Mar 16.

    PubMed 29550819
  • Hesse L, Eberl W, Schlaud M, Poets CF. Blood transfusion. Iron load and retinopathy of prematurity. Eur J Pediatr. 1997 Jun;156(6):465-70. doi: 10.1007/s004310050641.

    PubMed 9208245
  • Dani C, Reali MF, Bertini G, Martelli E, Pezzati M, Rubaltelli FF. The role of blood transfusions and iron intake on retinopathy of prematurity. Early Hum Dev. 2001 Apr;62(1):57-63. doi: 10.1016/s0378-3782(01)00115-3.

    PubMed 11245995
  • Inder TE, Clemett RS, Austin NC, Graham P, Darlow BA. High iron status in very low birth weight infants is associated with an increased risk of retinopathy of prematurity. J Pediatr. 1997 Oct;131(4):541-4. doi: 10.1016/s0022-3476(97)70058-1.

    PubMed 9386655
  • Hirano K, Morinobu T, Kim H, Hiroi M, Ban R, Ogawa S, Ogihara H, Tamai H, Ogihara T. Blood transfusion increases radical promoting non-transferrin bound iron in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2001 May;84(3):F188-93. doi: 10.1136/fn.84.3.f188.

    PubMed 11320046
  • Daruich A, Le Rouzic Q, Jonet L, Naud MC, Kowalczuk L, Pournaras JA, Boatright JH, Thomas A, Turck N, Moulin A, Behar-Cohen F, Picard E. Iron is neurotoxic in retinal detachment and transferrin confers neuroprotection. Sci Adv. 2019 Jan 9;5(1):eaau9940. doi: 10.1126/sciadv.aau9940. eCollection 2019 Jan.

    PubMed 30662950
  • Hellstrom A, Engstrom E, Hard AL, Albertsson-Wikland K, Carlsson B, Niklasson A, Lofqvist C, Svensson E, Holm S, Ewald U, Holmstrom G, Smith LE. Postnatal serum insulin-like growth factor I deficiency is associated with retinopathy of prematurity and other complications of premature birth. Pediatrics. 2003 Nov;112(5):1016-20. doi: 10.1542/peds.112.5.1016.

    PubMed 14595040
  • Luo XQ, Zhang CY, Zhang JW, Jiang JB, Yin AH, Guo L, Nie C, Lu XZ, Deng H, Zhang L. Identification of Iron Homeostasis Genes Dysregulation Potentially Involved in Retinopathy of Prematurity Pathogenicity by Microarray Analysis. J Ophthalmol. 2015;2015:584854. doi: 10.1155/2015/584854. Epub 2015 Oct 18.

    PubMed 26557385

Questions about this trial

What is this clinical trial studying?

An observational study of Retinopathy of Prematurity, run by Assistance Publique - Hôpitaux de Paris at 3 sites in France.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 3 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 20 Nov 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 3 sites in France. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

ROP screening (time frame: From 31 to 45 weeks' post menstrual age (PMA) [= (term + 4 weeks of life)].). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05133999, which also lists 12 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 20 Nov 2025.

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