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Severe retinopathy of prematurity and steroid exposure
D G Batton1, C Roberts, M Trese
1Department of Pediatrics, William Beaumont Hospital, Royal Oak, MI 48073-6769.
Insights
An increase in cryotherapy for retinopathy of prematurity in premature infants was observed. Steroid use for lung disease was significantly associated with the need for this treatment in this vulnerable population.
Area of Science:
- Neonatalogy
- Ophthalmology
- Pediatrics
Background:
- An increasing trend of severe retinopathy of prematurity (ROP) requiring cryotherapy was noted in infants born at 23-26 weeks' gestation between 1988-1990.
- This increase was not attributable to improved survival rates, prompting further investigation.
Purpose of the Study:
- To identify factors contributing to the rise in cryotherapy for severe ROP in extremely premature infants.
- To investigate the association between specific neonatal conditions and interventions with the need for ROP treatment.
Main Methods:
- A retrospective case-control study was performed on 52 surviving infants born between 23-26 weeks' gestation.
- Nine infants requiring cryotherapy for ROP were compared to 43 control infants.
- Statistical analysis examined 21 potential risk factors, including birthweight, gestational age, and various medical conditions and treatments.
Main Results:
- No significant differences were found in birthweight, gestational age, hyaline membrane disease, intraventricular hemorrhage, or hydrocephalus between groups.
- Factors associated with cryotherapy included patent ductus arteriosus (P = .046) and mechanical ventilation >21 days (P = .045).
- The use of steroids for lung disease showed a strong association with the need for cryotherapy (P < .001), particularly in infants dependent on mechanical ventilation for over 21 days.
Conclusions:
- The use of steroids for lung disease in extremely premature infants is significantly associated with an increased requirement for cryotherapy for severe retinopathy of prematurity.
- Further research is warranted to understand the mechanism behind steroid-induced ROP and to refine treatment protocols.
Abstract:
During a 3-year period (1988 through 1990) an increase was observed in the number of infants born at 23- to 26-weeks' gestation who required cryotherapy for severe retinopathy of prematurity (0/20, 1988; 3/14, 1989; 6/18, 1990; P = .015). Inasmuch as this was not related to improved survival, a retrospective case-control study was conducted to try to explain this observation. Of 52 surviving infants who had been born at 23 to 26 weeks' gestation, 9 required cryotherapy and the other 43 served as control subjects. There were no differences between groups in birthweight, gestational age, or the number of infants with hyaline membrane disease, intraventricular hemorrhage, or hydrocephalus. Factors related to the need for cryotherapy included patent ductus arteriosus (P = .046), mechanical ventilation for more than 21 days (P = .045), and the use of steroids for lung disease (P < .001). In this neonatal intensive care unit, steroids are administered according to the attending neonatologist's preference. Inasmuch as steroids are considered only for infants still ventilator dependent at 21 days, this group was analyzed separately (n = 36). Of the 21 factors examined, only the use of steroids for lung disease was associated with the need for cryotherapy (P < .001).