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Published on: November 20, 2015
Retinopathy of prematurity: risk stratification by gestational age
Tiffany Wu1, Rakesh Rao2, Hongjie Gu3
1Division of Ophthalmology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Insights
Risk factors for severe retinopathy of prematurity (sROP) differ by gestational age (GA). For extremely preterm infants (<24 weeks GA), delayed full feeding increases sROP risk. For later gestations, factors like bronchopulmonary dysplasia and patent ductus arteriosus impact sROP.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Perinatal Research
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in preterm infants.
- Identifying gestational age (GA)-specific risk factors is crucial for targeted interventions and improved outcomes.
Purpose of the Study:
- To identify gestational age (GA)-specific risk factors for severe ROP (sROP).
Main Methods:
- A single-center cohort study stratified infants by GA into three groups: <24 weeks, 24-26 weeks, and ≥27 weeks.
- Statistical analysis, including hazard ratios (HR), was used to determine risk factors for sROP within each GA stratum.
Main Results:
- 11.9% of infants developed sROP. For infants <24 weeks GA, time to full feeds was the only identified risk factor. For infants 24-26 weeks GA, higher GA was protective, while steroids for bronchopulmonary dysplasia (BPD), patent ductus arteriosus (PDA) ligation, and nitric oxide use increased sROP risk. Increasing birthweight was protective for infants ≥27 weeks GA.
- Cumulative hazard of sROP varied significantly by GA, reaching 1.0 by 15 weeks for the <24 weeks GA group and only 0.05 by 20 weeks for the ≥27 weeks GA group.
Conclusions:
- Risk factors, cumulative hazard, and the time course of sROP are significantly influenced by gestational age.
- These findings underscore the need for GA-specific management strategies to prevent severe ROP.
Objective:
To identify gestational age (GA) specific risk factors for severe ROP (sROP).
Study Design:
Single-center cohort stratified by GA into <24 weeks, 24-26 weeks and ≥27 weeks.
Results:
132/1106 (11.9%) developed sROP. Time to full feeds was the only risk factor [HR 1.003 (1.001-1.006), p = 0.04] for infants<24 weeks GA. For infants 24-26 weeks GA, a higher GA was protective [HR 0.66 (0.51-0.85), p < 0.01], whereas steroids for bronchopulmonary dysplasia (BPD) [HR 2.21 (1.28-3.26), p < 0.01], patent ductus arteriosus (PDA) ligation [HR 1.99 (1.25-3.11), p < 0.01] and use of nitric oxide [HR 1.96 (1.11-3.30), p = 0.01] increased the hazard of sROP. Increasing birthweight was protective [HR 0.70 (0.54-0.89), p < 0.01] in infants ≥27 weeks GA. Cumulative hazard of sROP reached 1.0 by fifteen weeks for <24 weeks GA, 0.4 by twenty weeks for 24-26 weeks GA, and 0.05 by twenty weeks after birth for ≥27 weeks GA.
Conclusions:
Risk factors, cumulative hazard, and time to sROP vary by GA.
