Related Experiment Video
Updated: Jul 25, 2025
Monitoring Dynamic Growth of Retinal Vessels in Oxygen-Induced Retinopathy Mouse Model
Published on: April 2, 2021
Prognostic Value of Parenteral Nutrition Duration on Risk of Retinopathy of Prematurity: Development and Validation
Aldina Pivodic1, Gerd Holmström2, Lois E H Smith3
1Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Parenteral nutrition duration (PND) of 14 days or more significantly increases the risk of retinopathy of prematurity (ROP) and its treatment. The updated DIGIROP 2.0 models show promise for improved ROP screening.
Area of Science:
- Neonatology
- Ophthalmology
- Medical Informatics
Background:
- The prognostic impact of parenteral nutrition duration (PND) on retinopathy of prematurity (ROP) requires further investigation.
- Predictive models are crucial for optimizing ROP screening and identifying high-risk infants.
Purpose of the Study:
- To assess the prognostic value of PND in ROP development and treatment.
- To update and validate the Digital ROP (DIGIROP) 2.0 prediction models, incorporating PND for all ROP-screened infants.
- To compare the performance of DIGIROP 2.0 against existing models like WINROP and G-ROP.
Main Methods:
- Retrospective analysis of 11,139 prematurely born infants from the Swedish National Registry for ROP (2007-2020).
- Statistical models (Extended Poisson, logistic) were used to analyze the relationship between PND and ROP outcomes.
- Model performance was evaluated using sensitivity, specificity, and area under the ROC curve; internal and external validations were conducted.
Main Results:
- PND of 14 days or more was significantly correlated with ROP severity (Spearman r=0.45, P<.001).
- Infants with PND ≥14 days had higher odds of any ROP (aOR=1.84) and ROP requiring treatment (aOR=2.20) compared to those with PND <14 days.
- The DIGIROP 2.0 models demonstrated 100% sensitivity for ROP detection, outperforming WINROP in specificity.
Conclusions:
- Extended PND (≥14 days) is a significant risk factor for ROP and the need for treatment.
- The updated DIGIROP 2.0 models, incorporating PND, offer high sensitivity and improved specificity for ROP screening.
- Findings support the use of DIGIROP 2.0 models over WINROP or G-ROP for managing ROP screening.
Importance:
The prognostic impact of parenteral nutrition duration (PND) on retinopathy of prematurity (ROP) is not well studied. Safe prediction models can help optimize ROP screening by effectively discriminating high-risk from low-risk infants.
Objective:
To evaluate the prognostic value of PND on ROP; to update and validate the Digital ROP (DIGIROP) 2.0 birth into prescreen and screen prediction models to include all ROP-screened infants regardless of gestational age (GA) and incorporate PND; and to compare the DIGIROP model with the Weight, IGF-1, Neonatal, and ROP (WINROP) and Postnatal Growth and ROP (G-ROP) models.
Design, Setting, And Participants:
This retrospective study included 11 139 prematurely born infants from 2007 to 2020 from the Swedish National Registry for ROP. Extended Poisson and logistic models were applied. Data were analyzed from August 2022 to February 2023.
Main Outcomes And Measures:
Any ROP and ROP requiring treatment were studied in relation to PND. ROP treatment was the outcome in DIGIROP models. Sensitivity, specificity, area under the receiver operating characteristic curve, and adjusted OR (aOR) with 95% CI were the main measures. Internal and external validations were performed.
Results:
Of 11 139 screened infants, 5071 (45.5%) were girls, and the mean (SD) gestational age was 28.5 (2.4) weeks. ROP developed in 3179 infants (29%), treatment was given in 599 (5%), 7228 (65%) had PND less than 14 days, 2308 (21%) had PND for 14 days or more, and 1603 (14%) had unknown PND. PND was significantly correlated with ROP severity (Spearman r = 0.45; P < .001). Infants with 14 days or more of PND vs less than 14 days had faster progression from any ROP to ROP treatment (adjusted mean difference, -0.9 weeks; 95% CI, -1.5 to -0.3; P = .004). Infants with PND for 14 days or more vs less than 14 days had higher odds of any ROP (aOR, 1.84; 95% CI, 1.62-2.10; P < .001) and of severe ROP requiring treatment (aOR, 2.20; 95% CI, 1.73-2.80; P < .001). Among all 11 139 infants, the DIGIROP 2.0 models had 100% sensitivity (95% CI, 99.4-100). The specificity was 46.6% (95% CI, 45.6-47.5) for the prescreen model and 76.9% (95% CI, 76.1-77.7) for the screen model. G-ROP as well as the DIGIROP 2.0 prescreen and screen models showed 100% sensitivity on a validation subset (G-ROP: sensitivity, 100%; 95% CI, 93-100; DIGIROP prescreen: sensitivity, 100%; 95% CI, 93-100; DIGIROP screen: sensitivity, 100%; 95% CI, 93-100), whereas WINROP showed 89% sensitivity (95% CI, 77-96). Specificity for each prediction model was 29% (95% CI, 22-36) for G-ROP, 38% (95% CI, 32-46) for DIGIROP prescreen, 53% (95% CI, 46-60) for DIGIROP screen at 10 weeks, and 46% (95% CI, 39-53) for WINROP.
Conclusion And Relevance:
Based on more than 11 000 ROP-screened infants born in Sweden, PND of 14 days or more corresponded to a significantly higher risk of having any ROP and receiving ROP treatment. These findings provide evidence to support consideration of using the updated DIGIROP 2.0 models instead of the WINROP or G-ROP models in the management of ROP.
Related Concept Videos
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...