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Dopamine use is an indicator for the development of threshold retinopathy of prematurity
M B Mizoguchi1, T G Chu, F M Murphy
1Department of Ophthalmology, University of California at Davis, Sacramento 95817, USA.
Insights
Dopamine treatment in premature infants may increase the risk of developing retinopathy of prematurity (ROP). Closer monitoring is advised for high-risk infants receiving dopamine for hypotension.
Area of Science:
- Neonatal Intensive Care
- Ophthalmology
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Systemic hypotension is common in very low birth weight infants, often requiring treatment with vasoactive drugs like dopamine.
Purpose of the Study:
- To investigate whether dopamine treatment for hypotension is a risk factor for the development of retinopathy of prematurity (ROP) in premature infants.
- To identify clinical factors associated with ROP development in this vulnerable population.
Main Methods:
- Retrospective case series analysis of 41 high-risk infants (birth weight < 1000 grams) in a neonatal intensive care unit (NICU).
- Infants were monitored for a minimum of 6 months with dilated indirect ophthalmoscopy to assess ROP progression.
- Comparison of ROP development between infants treated with dopamine for hypotension and those who were not.
Main Results:
- 18 of 41 infants received dopamine; 67% developed prethreshold ROP and 39% reached threshold ROP requiring laser treatment.
- Only 13% of non-dopamine treated infants progressed to prethreshold ROP, and 4% to threshold ROP (p < 0.05).
- Logistic regression identified dopamine use (aOR=119.88) and gestational age (aOR=0.061) as significant predictors of threshold ROP.
Conclusions:
- Dopamine administration for systemic hypotension in low birth weight infants appears to be a risk factor for threshold retinopathy of prematurity.
- Enhanced ophthalmic screening is recommended for premature infants requiring dopamine therapy.
Aim:
To assess whether treatment of premature infants with dopamine is a risk factor for development of retinopathy of prematurity (ROP).
Methods:
A retrospective case series analysis of two groups was utilised with a minimum follow up of 6 months. Clinical profiles and patient risk factors were identified along with an evaluation of ROP progression and an analysis of clinical outcome. All infants were seen in a single community neonatal intensive care unit (NICU). 41 consecutive high risk infants were identified during a 36 month period whose birth weight was less than 1000 grams and who remained in the NICU without transfer until at least 28 days of age. Dilated indirect ophthalmoscopy fundus examinations were performed on all infants to identify the degree of and progression to threshold ROP.
Results:
18 of 41 infants were treated with dopamine for hypotension. The group of infants requiring dopamine differed statistically from the non-dopamine treated group by having a slightly higher birth weight, a greater incidence of hypotension and colloid treatment, and in manifesting more advanced respiratory disease. Within the dopamine treated group, 12 of 18 infants (67%) reached prethreshold ROP and seven infants (39%) reached threshold ROP requiring laser treatment. In contrast, only three of the infants (13%) who did not require dopamine for hypotension progressed to prethreshold (p = 0.001) and only one of these infants (4%) progressed to threshold ROP (p = 0.02). Logistic regression analysis among other variables demonstrated that dopamine use and gestational age are important factors in this low birthweight population for predicting the development of threshold ROP (dopamine use: adjusted odds ratio = 119.88, p = 0.0061; gestational age: adjusted odds ratio = 0.061, p = 0.0043).
Conclusions:
Dopamine use in low birthweight infants may therefore be a risk factor for the development of threshold ROP. More vigilant screening of high risk infants requiring dopamine therapy for systemic hypotension may be warranted.
