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Potential Role of Bilirubin in Preventing Retinopathy of Prematurity
Hassan Boskabadi1, Naser Shoeibi2, Fatemeh Bagheri3
1Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Insights
Higher bilirubin levels in premature infants may protect against retinopathy of prematurity (ROP). Increased bilirubin is linked to less severe ROP, suggesting a need to reconsider routine phototherapy.
Area of Science:
- Neonatal ophthalmology
- Neonatal jaundice
- Biochemistry
Background:
- Retinopathy of prematurity (ROP) is a common complication in preterm neonates.
- Antioxidants show potential in preventing ROP development and progression.
- Bilirubin possesses antioxidant properties, prompting investigation into its role in ROP.
Purpose of the Study:
- To investigate bilirubin levels in neonates diagnosed with ROP.
- To compare bilirubin levels between neonates with and without ROP.
- To assess the correlation between bilirubin levels and ROP severity.
Main Methods:
- A case-control study involving very low birth weight (VLBW) neonates.
- Data collected included neonatal characteristics, maternal history, and laboratory results.
- ROP assessment was performed by a retina specialist; highest recorded bilirubin levels were analyzed.
Main Results:
- Out of 427 neonates, 266 (62.3%) had ROP.
- Significant differences were observed between ROP and control groups in birth weight, ventilation duration, oxygen therapy, Apgar scores, bilirubin levels, and gestational age.
- Higher ROP stages correlated with lower maximum bilirubin levels.
Conclusions:
- Elevated bilirubin levels in neonates may confer a protective effect against ROP.
- Increased bilirubin is associated with reduced ROP severity.
- Prophylactic phototherapy for premature infants may warrant re-evaluation.
Background:
One of the most common problems in preterm neonates is retinopathy of prematurity (ROP). It has been shown antioxidants may be effective in preventing the development and progression of ROP. Considering the antioxidant properties of bilirubin, we decided to investigate the bilirubin level in neonates with ROP and compare it with healthy neonates.
Methods:
This case-control study was performed on VLBW neonates admitted to the NICU of Ghaem Hospital in Mashhad between 2014 and 2020 for a Jaundice evaluation. Complete neonate's characteristics, maternal history and laboratory results were collected in a questionnaire. Then the neonates were examined for ROP by a fellowship of the retina of an ophthalmologist at 32 weeks or four weeks after birth. The highest bilirubin levels during their hospitalization were also recorded.
Results:
Of 427 neonates examined, 121 (37.7%) had a normal eye examination, and 266 (62.3%) had ROP. The mean weight, gestational age and bilirubin were 1455.8 ± 431.4 grams, 31.6 ± 2.3 weeks and 8.8 ± 2.4 mg/dl, respectively. There was a significant difference between controls and neonates with ROP with regard to birth weight, duration of intermittent positive pressure ventilation (IPPV), duration of oxygen therapy, first and fifth minute Apgar scores, the maximum level of bilirubin and gestational age (P < 0.05). It was observed that the maximum level of bilirubin was lower in neonates with higher stages of ROP.
Conclusion:
According to the results of this study, higher levels of bilirubin in neonates may be a protective factor against ROP. Moreover, increased levels of bilirubin are associated with reduced severity of ROP. Therefore, prophylaxis phototherapy in premature infants may need to be reconsidered.
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