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Efficacy comparison of 21 interventions to prevent retinopathy of prematurity: a Bayesian network meta-analysis of
Miao Zhou1,2, Pei-Chen Duan1, Dan-Lin Li1
1School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
Insights
Vitamin A supplementation is the most effective intervention for preventing retinopathy of prematurity (ROP) in premature infants. This finding is based on a network meta-analysis of 106 randomized controlled trials.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Current interventions for ROP prevention have varying degrees of efficacy.
- A comprehensive comparative analysis of these interventions is needed.
Purpose of the Study:
- To evaluate and compare the efficacy of various interventions for preventing ROP in preterm infants.
- To identify the most effective strategy for ROP prevention through a rigorous meta-analysis.
Main Methods:
- A network meta-analysis (NMA) was conducted, synthesizing data from 106 randomized controlled trials (RCTs).
- Studies included preterm infants (<37 weeks gestational age) and reported ROP incidence.
- Data were pooled using a random effects model to determine overall treatment effects.
Main Results:
- Vitamin A supplementation demonstrated a significant reduction in ROP incidence compared to placebo and other interventions.
- Interventions showing reduced ROP incidence include fish oil-based lipid emulsion, early erythropoietin, probiotics, and human milk.
- Vitamin A supplementation exhibited the highest probability (SUCRA 92.50%) of being the optimal intervention for ROP risk reduction.
Conclusions:
- Vitamin A supplementation emerges as a potentially superior method for preventing ROP among 21 evaluated interventions.
- These findings provide a valuable resource for developing and refining ROP preventive strategies.
- Further research can build upon this evidence to optimize neonatal eye care.
Background:
The objective of this study was to evaluate the comparative efficacy of current interventions for the prevention of retinopathy of prematurity (ROP) in premature infants.
Methods:
A network meta-analysis (NMA) was performed. We searched PubMed, Web of Science, Scopus, Embase, and the Cochrane Library for relevant studies from their inception to May 5, 2022. Publications were eligible for our study if they were randomized controlled trials (RCTs) involving preterm infants at <37 weeks of gestational age and reported the incidence of any-stage ROP treated with the interventions of interest. The overall effect was pooled using the random effects model.
Results:
We identified 106 RCTs (involving 23894 participants). This NMA showed that vitamin A supplementation markedly reduced the incidence of ROP, in comparison with placebo (odds ratio [OR] = 0.59, 95% credible interval [95% CrI] 0.33, 0.85), fish oil-based lipid emulsion (OR = 0.57, 95% CrI 0.24, 0.90), early erythropoietin (OR = 0.51, 95% CrI 0.34, 0.98), probiotics (OR = 0.48, 95% CrI 0.32, 0.97), and human milk (OR = 0.50, 95% CrI 0.21, 0.78). Vitamin A supplementation has the highest probability of being the best option for reducing the ROP risk compared with the other 20 interventions based on its surface under the cumulative ranking curve (SUCRA) value (SUCRA = 92.50%, 95% CrI 0.71, 1.00).
Conclusions:
Our findings suggest that among 21 interventions, vitamin A supplementation might be the best method of preventing ROP. This NMA offers an important resource for further efforts to develop preventive strategies for ROP.
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