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Do postnatal glucocorticoids and retinopathy of prematurity relate?
J Termote1, N E Schalij-Delfos, A R Donders
1Department of Neonatology, Wilhelmina Children's Hospital, University of Utrecht,The Netherlands.
Insights
Postnatal glucocorticoids like hydrocortisone did not increase the risk of retinopathy of prematurity (ROP) in preterm infants. However, prolonged hydrocortisone use in infants with ROP was linked to a higher risk of severe ROP.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in preterm infants.
- Bronchopulmonary dysplasia (BPD) is a common complication in preterm infants, often treated with postnatal glucocorticoids.
- The potential association between postnatal glucocorticoid use and ROP incidence/severity requires further investigation.
Purpose of the Study:
- To investigate the relationship between postnatal hydrocortisone use and the incidence and severity of ROP.
- To assess the risk of ROP and severe ROP in preterm infants treated with hydrocortisone for BPD.
Main Methods:
- Retrospective study comparing 161 preterm infants treated with hydrocortisone for BPD against 253 controls.
- Data collected over a 4-year period.
- Logistic regression analysis used to determine associations.
Main Results:
- Overall ROP incidence was 62.7% in the hydrocortisone group vs. 21.3% in controls.
- Severe ROP incidence was 5% in the treatment group vs. 0.4% in controls.
- Postnatal hydrocortisone was not significantly associated with increased ROP risk (OR 1.387, p=0.272) or severe ROP risk (OR 4.112, p=0.16).
- Prolonged hydrocortisone use in infants with ROP was associated with increased severe ROP risk (OR 1.02, p=0.03).
Conclusions:
- Postnatal hydrocortisone therapy was not found to be an independent risk factor for developing ROP or severe ROP.
- Prolonged use of hydrocortisone in infants already diagnosed with ROP may increase the risk of severe ROP.
- Further research is warranted to clarify the nuanced relationship between glucocorticoids and ROP outcomes.
Abstract:
To study a possible relation between the use of postnatal glucocorticoids and the incidence and severity of retinopathy of prematurity (ROP), we conducted a retrospective study over a 4-year period that compared data of 161 preterm infants treated with hydrocortisone for bronchopulmonary dysplasia (BPD) with the data of 253 controls. The incidence of overall ROP was 62.7% in the hydrocortisone group and 21.3% in the control group. The incidence of severe ROP (stages 3-5) was 5% in the treatment group and 0.4% in the control group. Using logistic regression, postnatal hydrocortisone therapy was not associated with an increased risk for ROP or severe ROP (OR 1.387, 95% confidence interval 0.773-2.489, p = 0.272 and OR 4.112, 95% C.I. 0.44-38.37, p = 0.16, respectively). Also, in a subgroup of extremely low-birth-weight infants (<1000 g), postnatal hydrocortisone had no influence on the incidence of (severe) ROP. In the infants with ROP (n = 155), only prolonged use of postnatal hydrocortisone was associated with an increased risk for severe ROP (OR 1.02, 95% C.I. 1.00-1.03, p = 0.03). In this study postnatal use of hydrocortisone was not associated with an increased risk for (severe) ROP. However, in infants already suffering from ROP, prolonged treatment with hydrocortisone concurred with an increased risk for severe ROP.