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A prospective study on hyperglycemia and retinopathy of prematurity
L Mohsen1, M Abou-Alam1, M El-Dib2
1Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.
Insights
Neonatal hyperglycemia, or high blood sugar in newborns, is independently linked to retinopathy of prematurity (ROP), a condition causing blindness in premature infants. This prospective study confirms hyperglycemia as a significant risk factor for ROP development.
Area of Science:
- Neonatology
- Ophthalmology
- Endocrinology
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants.
- Previous studies suggest a link between neonatal hyperglycemia and ROP, but lacked prospective data.
- The independent association of hyperglycemia with ROP, controlling for comorbidities, remained unclear.
Purpose of the Study:
- To prospectively investigate if hyperglycemia in premature infants is independently associated with ROP development.
- To determine the risk of ROP in relation to blood glucose levels in the first week of life.
Main Methods:
- A prospective longitudinal cohort study enrolled premature infants (<1500g or ≤32 weeks gestational age).
- Blood glucose was monitored daily; hyperglycemia defined as ≥150 mg/dL.
- Bivariate and logistic regression analyses were used to identify independent risk factors for ROP.
Main Results:
- Of 65 infants, 48% had hyperglycemia, and 29.2% developed ROP.
- ROP incidence was significantly higher in the hyperglycemia group (45% vs. 15%, P=0.007).
- Average blood glucose in the first week was independently associated with ROP (OR: 1.77, P=0.024), even after accounting for factors like gestational age and oxygen exposure.
Conclusions:
- Elevated average blood glucose concentrations in the first week of life are independently associated with ROP in premature infants.
- This finding highlights the importance of glycemic control in preventing ROP.
Objective:
Retinopathy of prematurity (ROP) constitutes a significant morbidity in premature infants that can lead to blindness. Multiple retrospective studies have identified neonatal hyperglycemia as a risk for developing ROP. However, in the absence of any reported prospective study, it is not clear whether hyperglycemia is associated with ROP independent of the commonly associated comorbidities. The objective of this study was to investigate whether hyperglycemia in premature infants is independently associated with ROP.
Study Design:
Premature infants (<1500 g or⩽32 weeks gestational age) were enrolled in a prospective longitudinal cohort study. All demographic, clinical and laboratory data were collected. Bedside whole-blood glucose concentration was measured every 8 h daily for 7 days. For any glucose reading<50 or>150 mg dl(-1), serum sample was sent to the laboratory for confirmation. Hyperglycemia was defined as any blood glucose level⩾150 mg dl(-1). ROP patients were compared with non-ROP patients in a bivariate analysis. Variables significantly associated with ROP were studied in a logistic regression model.
Result:
A total of 65 patients were enrolled with gestational age 31.1±1.2 weeks and birth weight 1385±226 g. Thirty-one patients (48%) were identified with hyperglycemia. On eye examination, 19 cases (29.2%) had ROP (13 with stage 1, 4 with stage 2 and 2 with stage 3). There were more cases of ROP in the hyperglycemia group compared with the euglycemia group (45% vs 15%, P=0.007). Patients who developed ROP had significantly higher maximum and average glucose concentrations when compared with non-ROP patients. Multiple factors have been associated with ROP on bivariate analysis, including gestational age, exposure to oxygen, respiratory support and poor weight gain. However, in a logistic regression model including all significant variables, average blood glucose in the first week of life was the factor independently associated with ROP with an odds ratio of: 1.77 (95% confidence interval: 1.08 to 2.86), P=0.024.
Conclusion:
In a cohort of premature infants, elevated average blood glucose concentrations in the first week of life is independently associated with the development of ROP.
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