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[Retinopathy of prematurity: why are girls more frequently affected?]
V Seiberth1, U Legler, M C Knorz
1Universität-Augenklink, Klinikum Mannheim, Fakultät für Klinische Medizin der Universität, Heidelberg, Mannheim, Bundesrepublik, Deutschland.
Insights
Retinopathy of prematurity (ROP) was more common in premature girls than boys. Higher mortality in premature boys, not biological sex, explains this observed difference in ROP prevalence.
Area of Science:
- Ophthalmology
- Neonatology
- Perinatal Medicine
Context:
- Retinopathy of prematurity (ROP) affects premature infants.
- Previous studies suggested a higher prevalence of ROP in female infants.
- This study investigates the sex-specific incidence and contributing factors of ROP.
Purpose:
- To determine the prevalence of retinopathy of prematurity (ROP) in premature infants based on sex.
- To explore potential factors influencing the observed sex ratio in ROP, including mortality rates.
Summary:
- A prospective study of 226 premature infants (birth weight ≤ 1500 g) from 1986-1988 found ROP in 31.0% of girls and 22.3% of boys (p=0.042).
- Significantly higher mortality was observed in premature boys (29.2%) compared to girls (13.5%) (p=0.001).
- The higher apparent prevalence of ROP in girls is attributed to the higher mortality rate in boys, not an intrinsic biological difference.
Impact:
- Highlights the importance of considering mortality rates when interpreting sex-based prevalence data in neonatal studies.
- Suggests that the observed higher prevalence of ROP in girls may be an artifact of differential mortality.
- Informs clinical understanding and research into the multifactorial etiology of retinopathy of prematurity.
Abstract:
In 226 prematures (birth weight less than or equal to 1500 g), who were examined prospectively between 1986 and 1988, retinopathy of prematurity occurred significantly more often in girls: 31.0% of the eyes of 134 girls and 22.3% of the eyes of 92 boys showed retinopathy of prematurity (p = 0.042). Different factors may influence the sex ratio of retinopathy of prematurity: (1) hormonal differences are already present shortly after birth; (2) there are different ventilation rates in girls and boys; (3) the mortality varies between girls and boys. The influence of mortality was demonstrated in the group of preterms examined: in this time period, 59 of 285 prematures died: 21 of 155 girls (13.5%) and 38 of 130 boys (29.2%). Significantly more boys than girls died (p = 0.001). For this reason the percentage of surviving girls at high risk of having retinopathy is high. The apparently greater prevalence in girls is the result.