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Late postnatal systemic steroids predispose to retinopathy of prematurity in very-low-birth-weight infants: a
Tatiana Smolkin1, Maya Steinberg, Polo Sujov
1Department of Neonatology, Meyer Children's Hospital, Rambam Health Care Campus, Israel.
Insights
Systemic steroids given to premature infants may increase the risk of retinopathy of prematurity (ROP). This study found a significant association between late postnatal systemic steroid use and ROP development in very-low-birth-weight infants.
Area of Science:
- Neonatal ophthalmology
- Perinatal medicine
- Pediatric critical care
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Very-low-birth-weight (VLBW) infants are particularly susceptible to ROP.
- While prematurity and hyperoxia are known risk factors, other contributing factors are under investigation.
Purpose of the Study:
- To identify risk factors for ROP in VLBW infants.
- To compare preemies with and without ROP to uncover associated variables.
- To investigate the role of specific medical interventions in ROP development.
Main Methods:
- A case-control study comparing 27 VLBW infants with ROP to 27 matched controls without ROP.
- Data collected included demographic, maternal, gestational, intrapartum, neonatal, interventional, growth, and ophthalmologic parameters.
- Statistical analysis involved univariate and multivariate logistic regression, controlling for gestational age.
Main Results:
- Eleven variables initially differed between ROP and control groups.
- Seven variables remained significant after controlling for gestational age, primarily related to respiratory morbidity and interventions.
- Systemic steroid use for bronchopulmonary dysplasia was the only variable independently associated with ROP (OR 5.42, p=0.007).
Conclusions:
- Late postnatal systemic steroid administration was significantly more common in VLBW infants who developed ROP.
- Systemic steroids may contribute to ROP pathogenesis, potentially by affecting insulin growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF).
- Further research is warranted to elucidate the mechanism and clinical implications.
Background And Objective:
Retinopathy of prematurity (ROP) develops mostly in very-low-birth-weight (VLBW) premature infants. Besides prematurity and hyperoxia, other variables have been brought up as risk factors for ROP. We aimed to search risk factors for ROP by comparing two groups of preemies, one with and the other without ROP.
Patients And Methods:
During 2004-2006, 27 VLBW premature infants developed ROP (ROP group). For each neonate in the ROP group, we chose a neonate born at similar gestational age (GA) (+/-1 week) but without ROP (control group). For each neonate of both groups, we recorded demographic, maternal, gestational, intrapartum, neonatal, interventional, growth and ophthalmologic data from patients' medical records.
Results:
Eleven of the tested variables were significantly different between the ROP and control groups in univariate analysis. However, only seven of these variables remained significantly different between groups when controlling each variable for GA: bronchopulmonary dysplasia (BPD, p=0.04), duration of hospitalization (p=0.017), high-frequency oscillatory ventilation (HFOV, p=0.033), duration of oxygen therapy (p=0.023), surfactant therapy (p=0.045), inhaled steroids (p=0.015) and systemic steroids for BPD (p=0.007). These seven significant variables were related to respiratory morbidity and interventions. Multiple stepwise logistic regression including all significant variables in the univariate analysis showed that only systemic steroids remained significantly different between groups (p=0.007, OR 5.42, 95% CI 1.60-18.34).
Conclusion:
Significantly more neonates in the ROP group received late postnatal systemic steroids as compared to controls. We speculate that steroids, by altering insulin growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF) expression, might contribute to the pathogenesis of ROP.
