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Retinopathy of prematurity and risk factors: a prospective cohort study
Padmani Karna1, Jyotsna Muttineni, Linda Angell
1Division of Neonatology, Pediatrics and Human Development, Michigan State University, East Lansing, USA. karna@msu.edu
Insights
Late postnatal steroid use in premature infants increases the risk of severe retinopathy of prematurity (ROP). This finding suggests that steroid treatment timing and duration are critical for ROP prevention in vulnerable newborns.
Area of Science:
- Neonatal care
- Ophthalmology
- Perinatology
Background:
- Advances in neonatal care have increased survival rates for extremely low birth weight infants, leading to a higher incidence of retinopathy of prematurity (ROP).
- The role of antenatal and postnatal steroids in ROP severity is debated, with uncertainty regarding whether observed ROP is due to treatment or underlying illness severity.
Purpose of the Study:
- To investigate the association between severe retinopathy of prematurity (ROP) and factors including mechanical ventilation, oxygen therapy, gestational age, and antenatal/postnatal steroid use in extremely low birth weight infants.
Main Methods:
- A retrospective study of neonates admitted to a neonatal intensive care unit between 1993-2000.
- Ophthalmologic examinations were conducted from 6 weeks until ROP resolution.
- Logistic regression analysis was used to determine the odds ratio for ROP risk factors.
Main Results:
- Severe ROP was detected in 7.8% of eligible neonates; lower gestational age (<28 weeks) significantly increased ROP risk.
- Late postnatal steroid treatment (after 3 weeks, especially for ≥2 weeks) was associated with a 2.9-fold increased odds ratio for severe ROP.
- Lower gestational age, ventilation dependence, and postnatal steroid use were interconnected, potentially indicating severe illness.
Conclusions:
- Prolonged or late-onset postnatal steroid therapy may elevate the risk of severe ROP in very low birth weight infants.
- Postnatal steroid use might also serve as an indicator of underlying illness severity.
- Further research is needed to explore biological markers in ROP pathogenesis and the impact of various therapeutic interventions.
Background:
Increased survival of extremely low birth infants due to advances in antenatal and neonatal care has resulted in a population of infants at high risk of developing retinopathy of prematurity (ROP). Therapeutic interventions include the use of antenatal and postnatal steroids however, their effects on the severity of ROP is in dispute. In addition, it has not been investigated whether severe ROP is due to therapeutic interventions or due to the severity of illness. The aim of the present study was to assess the association between the incidence of severe retinopathy of prematurity (greater than stage 2 - International classification of ROP) and mechanical ventilation, oxygen therapy, gestational age, antenatal and postnatal steroids in extremely low birth weight infants.
Methods:
Neonates admitted to the neonatal intensive care unit in Lansing, Michigan, during 1993-2000 were followed to determine factors influencing the development of severe retinopathy of prematurity. Ophthalmologic examinations were started at 6 weeks and followed until resolution. We used logistic regression to estimate the relative risk (odds ratio) associated with risk factors of ROP.
Results:
Of the neonates with
Conclusion:
Prolonged and late postnatal steroids treatment in very low birth weight infants may pose an increased risk for the development of severe retinopathy of prematurity; however, use of postnatal steroids may also be a marker for severity of illness. Further studies need to focus on biologic markers in the pathogenesis of retinopathy of prematurity and to better understand the influence of therapies.
