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Race, Candida sepsis, and retinopathy of prematurity
Misrak Tadesse1, Ramasubbareddy Dhanireddy, Mahdur Mittal
1Department of Pediatrics, Division of Neonatology, Georgetown University Children's Medical Center, Washington, DC 20007, USA.
Insights
African-American infants with extremely low birth weight have a lower incidence of severe retinopathy of prematurity (ROP). This finding suggests race is a protective factor against severe ROP in this vulnerable population.
Area of Science:
- Neonatalogy
- Ophthalmology
- Perinatal Medicine
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Extremely-low-birth-weight (ELBW) infants (< 1,000 g) are at highest risk for developing ROP.
- Factors influencing ROP severity, including race, require further investigation.
Purpose of the Study:
- To investigate the association between race, Candida sepsis, and oxygen exposure duration with ROP severity in ELBW infants.
- To determine if African-American race is a protective factor against severe ROP.
- To identify risk factors for severe ROP in a cohort of ELBW infants.
Main Methods:
- Observational cohort study conducted at Georgetown University Hospital from 1994-1997.
- Inclusion criteria: infants with birth weight <= 1,000 g.
- Statistical analysis included multiple logistic regression to identify independent risk factors.
Main Results:
- Overall ROP incidence was 70.8%.
- Caucasian infants had a significantly higher incidence of stage III or greater ROP (46.7%) compared to African-American infants (23.8%).
- African-American race was an independent protective factor against severe ROP (adjusted odds ratio 0.39).
Conclusions:
- African-American ELBW infants are less likely to develop severe ROP than Caucasian infants, even with similar illness severity.
- Race appears to be an independent protective factor against severe ROP.
- Further research into the biological mechanisms underlying this racial disparity is warranted.
Abstract:
The objective of this observational cohort study at Georgetown University Hospital from January 1, 1994 through December 31, 1997 was to investigate race, Candida sepsis, and duration of oxygen exposure in infants with retinopathy of prematurity (ROP) with birth weight < or = 1,000 g. The incidence of ROP was 70.8% (114/161). The incidence of stage III or greater ROP in the Caucasian infants was significantly higher at 46.7% (14/30) than in the African-American infants at 23.8% (20/84) with p < 0.02. In addition, the incidence of threshold disease was higher in Caucasian infants 33.3% (10/30) when compared to African-American infants 9.5% (8/84) with p < 0.002. Using multiple logistic regression, African-American race was found to be an independent protective factor against developing severe ROP [adjusted odds ratio 0.39; 95% confidence interval (UCI) 0.16-0.97]. Extremely-low-birth-weight African-American infants with comparable severity of illness (including birth weight, gestational age, duration of supplemental oxygen exposure, and Candida sepsis) are less likely to develop severe ROP than Caucasian infants.