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Retinopathy of prematurity and antenatal corticosteroids. The Italian ROP Study Group
V Console1, L Gagliardi, A De Giorgi
1Division of Neonatology and Neonatal Intensive Care Unit, Ospedale Niguarda, Milano.
Insights
Antenatal corticosteroids (ANS) significantly reduce the risk of retinopathy of prematurity (ROP) and its severe forms in preterm infants. Prematurity and respiratory issues remain independent ROP risk factors.
Area of Science:
- Neonatalogy
- Ophthalmology
- Perinatal Medicine
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- The role of antenatal corticosteroids (ANS) in preventing ROP is not well-established.
Purpose of the Study:
- To evaluate the effect of antenatal corticosteroids (ANS) on the development and severity of retinopathy of prematurity (ROP).
Main Methods:
- Prospective cohort study involving 380 infants with gestational age ≤ 30 weeks across 14 centers.
- Data collected on ROP development (stage 1-3+) and severity, with ANS prophylaxis received by 18.4% of infants.
Main Results:
- ANS prophylaxis significantly reduced the risk of developing any ROP (OR 0.35) and severe ROP (OR 0.07).
- Short gestation, low birth weight, and bronchopulmonary dysplasia were associated with ROP. Respiratory distress syndrome and lack of surfactant treatment were linked to ROP severity.
Conclusions:
- Antenatal corticosteroids (ANS) offer protection against ROP development and severe ROP.
- Prematurity and respiratory morbidity remain independent risk factors for ROP.
Objectives:
It is not known whether antenatal corticosteroids (ANS) can reduce the risk of retinopathy of prematurity (ROP). The aim of this study was to evaluate in a prospective cohort study the effect of ANS on ROP development and severity.
Methods:
All infants consecutively admitted to 14 centres from 1.1.1992 to 31.12.1993, with a gestational age < or = 30 weeks, no congenital anomalies, and who survived to 6 months, were enrolled (N = 380). Mean birth weight of the cohort was 1157 g; mean gestational age was 28.4 weeks. ROP stage 1-2 developed in 82 neonates; ROP stage 3-3+ in 57. Only 70 neonates (18.4%) received ANS prophylaxis.
Results:
ANS prophylaxis highly significantly reduced the risk of developing ROP [Odds ratio, (OR), 0.35; 95% confidence interval 0.17-0.71, logistic regression analysis], and that of severe (stage 3-3+) ROP (OR 0.07; 95% confidence interval: 0.02-0.34). Short gestation, low birth weight, bronchopulmonary dysplasia also were significantly associated with ROP development and severity; respiratory distress syndrome and not being treated with surfactant were significant risk factors for ROP severity.
Conclusions:
ANS prophylaxis protected both against ROP development and against severe forms of ROP. Prematurity and respiratory morbidity still represent independent risk factors for ROP.