Insulin, Hyperglycemia, and Severe Retinopathy of Prematurity in Extremely Low-Birth-Weight Infants

Area of Science:

• Neonatalogy
• Ophthalmology
• Endocrinology

Background:

• Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
• Extremely low-birth-weight (ELBW) infants are at high risk for ROP.
• The roles of hyperglycemia and insulin therapy in ROP development are not fully understood.

Purpose of the Study:

• To investigate the association between hyperglycemia, insulin therapy, and severe ROP in ELBW infants.
• To analyze the impact of blood glucose levels and insulin use on the incidence of severe ROP.

Main Methods:

• Retrospective database study of ELBW infants (gestational age ≤ 32 weeks).
• Multivariable analysis to assess the association between hyperglycemia (blood glucose > 180 mg/dL) and severe ROP.
• Covariates included gestational age, small for gestational age status, sex, ventilation, oxygen use, and steroid exposure.
• Sensitivity analyses performed with different hyperglycemia thresholds (BG > 150 mg/dL and > 200 mg/dL).

Main Results:

• A total of 24,548 ELBW infants were analyzed; 10% developed severe ROP.
• Hyperglycemia alone was not significantly associated with severe ROP (OR, 0.88; 95% CI, 0.66-1.17).
• Hyperglycemia with insulin use was not significantly associated with severe ROP (OR, 1.43; 95% CI, 0.91-2.23).
• However, hyperglycemia defined as BG > 150 mg/dL combined with insulin use showed an association with severe ROP (OR, 1.34; 95% CI, 1.02-1.76).

Conclusions:

• Hyperglycemia in ELBW infants is not independently associated with severe ROP.
• A potential trend suggests a possible association between insulin use and severe ROP, particularly at lower hyperglycemia thresholds.
• Further research is warranted to elucidate the complex relationship between glucose metabolism, insulin therapy, and ROP development.