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Prenatal and postnatal inflammation-related risk factors for retinopathy of prematurity
Gregory P Goldstein1, Stephanie A Leonard2,3, Peiyi Kan2
1Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA. gpgold@stanford.edu.
Insights
Postnatal inflammation is linked to severe retinopathy of prematurity (ROP). Prenatal inflammation
Area of Science:
- Neonatal Perinatal Medicine
- Ophthalmology
- Pediatric Critical Care
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Inflammation is implicated in ROP pathogenesis, but the roles of prenatal and postnatal factors require clarification.
Purpose of the Study:
- To investigate the association between prenatal and postnatal inflammation-related risk factors and the development of severe retinopathy of prematurity (ROP).
Main Methods:
- A cohort study of 14,816 infants born before 30 weeks gestation in California (2007-2011).
- Multivariable log-binomial regression and mediation analysis were employed to assess risk factor associations.
- Severe ROP was defined as stage 3-5 ROP or requiring surgery.
Main Results:
- 10.8% of infants developed severe ROP.
- Prenatal inflammation-related factors showed an initial association with severe ROP, but this became non-significant after accounting for gestational age via mediation analysis.
- Postnatal factors significantly associated with severe ROP included prolonged oxygen exposure, sepsis, intraventricular hemorrhage, and necrotizing enterocolitis.
Conclusions:
- Postnatal inflammation-related factors demonstrate a stronger association with severe ROP compared to prenatal factors.
- The apparent link between prenatal inflammation and severe ROP is largely mediated by earlier gestational age at birth.
Objective:
To evaluate the relationship between prenatal and postnatal inflammation-related risk factors and severe retinopathy of prematurity (ROP).
Study Design:
The study included infants born <30 weeks in California from 2007 to 2011. Multivariable log-binomial regression was used to assess the association between prenatal and postnatal inflammation-related exposures and severe ROP, defined as stage 3-5 or surgery for ROP.
Results:
Of 14,816 infants, 10.8% developed severe ROP. Though prenatal inflammation-related risk factors were initially associated with severe ROP, after accounting for the effect of these risk factors on gestational age at birth through mediation analysis, the association was non-significant (P = 0.6). Postnatal factors associated with severe ROP included prolonged oxygen exposure, sepsis, intraventricular hemorrhage, and necrotizing enterocolitis.
Conclusion:
Postnatal inflammation-related factors were associated with severe ROP more strongly than prenatal factors. The association between prenatal inflammation-related factors and ROP was explained by earlier gestational age in infants exposed to prenatal inflammation.
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