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Aggressive Posterior Retinopathy of Prematurity Is Associated with Multiple Infectious Episodes and Thrombocytopenia
Pia Lundgren1, Linnea Lundberg, Gunnel Hellgren
1Section for Ophthalmology, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Multiple infections and low platelet counts (thrombocytopenia) in preterm infants are linked to aggressive posterior retinopathy of prematurity (APROP). These factors, especially around diagnosis, increase APROP risk.
Area of Science:
- Neonatal Ophthalmology
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Aggressive posterior retinopathy of prematurity (APROP) is a severe form of ROP causing significant vision loss in preterm infants.
- Despite timely laser treatment, APROP outcomes remain poor, necessitating investigation into contributing factors.
Purpose of the Study:
- To identify postnatal characteristics associated with the development of APROP in a Swedish national cohort.
- To explore the relationship between infectious episodes, thrombocytopenia, and APROP incidence.
Main Methods:
- A retrospective, 1:1 matched case-control study design was employed.
- Data from medical records of APROP cases (n=9) and matched controls (n=9) were analyzed for birth characteristics, postnatal morbidities, and blood analyses.
- Infectious episodes and thrombocytopenia were specifically defined and assessed.
Main Results:
- All APROP cases experienced at least two infectious episodes and thrombocytopenia within the first month.
- APROP cases showed significantly higher rates of necrotizing enterocolitis and sepsis compared to controls.
- APROP cases had considerably lower median platelet counts, particularly around the time of ROP diagnosis.
Conclusions:
- Recurrent infectious episodes and thrombocytopenia are strongly associated with APROP development in preterm infants.
- Thrombocytopenia occurring around the time of ROP diagnosis is a critical factor in APROP.
- These findings highlight potential targets for intervention to prevent severe visual impairment in ROP.
Background:
The most severe form of rapidly progressing retinopathy of prematurity (ROP) is termed aggressive posterior ROP (APROP). APROP frequently causes severe visual impairment in affected preterm infants despite timely and appropriate laser treatment.
Objectives:
We investigated the postnatal characteristics associated with APROP development in a national Swedish cohort.
Methods:
This retrospective, 1:1 matched case-control study included all infants that developed APROP in zone 1 (n = 9) between 2008 and 2012. Control infants, matched for gestational age and birth weight, developed ROP no worse than stage 2 (n = 9). We retrieved data from medical records on infant birth characteristics, postnatal morbidities, and blood analyses from birth to the first ROP treatment. Infectious episodes included sepsis, C-reactive protein ≥10 mg/l, and other clinical signs of infection that required antibiotic treatment. A platelet count <100 × 109/l was considered to be thrombocytopenia.
Results:
All APROP cases postnatally developed at least two infectious episodes, one in the first month and one around the time of ROP diagnosis. All APROP cases exhibited thrombocytopenia in the first month, and 6/9 exhibited thrombocytopenia around the time of ROP diagnosis. Compared to the controls, APROP cases more frequently developed necrotizing enterocolitis (8/9 vs. 1/9; p < 0.01) and sepsis (9/9 vs. 3/9; p < 0.01), and they had significantly lower median platelet counts (90 × 109/l, range 4-459, vs. 158 × 109/l, range 20-500; p < 0.001).
Conclusion:
Multiple infectious episodes and thrombocytopenia, particularly around the time of ROP diagnosis, were associated with APROP development.
