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Published on: November 20, 2015
Neonatal Sepsis Episodes and Retinopathy of Prematurity in Very Preterm Infants
Kirsten Glaser1, Christoph Härtel2, Claus Klingenberg3,4
1Division of Neonatology, Department of Women's and Children's Health, University of Leipzig Medical Center, Leipzig, Germany.
Insights
Neonatal sepsis significantly increases the risk of retinopathy of prematurity (ROP) in preterm infants. Recurrent sepsis episodes correlate with higher rates of ROP and the need for treatment, highlighting sepsis as a critical factor in ROP development.
Area of Science:
- Neonatalogy
- Ophthalmology
- Infectious Diseases
Background:
- Retinopathy of prematurity (ROP) is a leading cause of visual impairment and blindness in preterm infants.
- Neonatal sepsis is increasingly recognized as a contributing factor to ROP development.
- Timely intervention and prevention strategies are crucial for managing ROP.
Purpose of the Study:
- To investigate the association between neonatal sepsis and ROP in two large cohorts of extremely preterm infants.
- To determine if the number of sepsis episodes influences the incidence of ROP and treatment-warranted ROP.
Main Methods:
- Retrospective cohort study utilizing data from the German Neonatal Network (GNN) and Norwegian Neonatal Network (NNN).
- Inclusion of preterm infants born at less than 29 weeks' gestation.
- Analysis of culture-proven sepsis episodes and their correlation with any ROP and treatment-warranted ROP.
Main Results:
- In the GNN cohort, increasing episodes of sepsis were significantly associated with higher rates of ROP and treatment-warranted ROP.
- Adjusted odds ratios indicated a dose-response relationship between sepsis episodes and ROP severity.
- Propensity score matching confirmed the association between sepsis and ROP, with surgical necrotizing enterocolitis also linked to treatment-warranted ROP in the NNN cohort.
Conclusions:
- Recurrent culture-proven neonatal sepsis is a significant risk factor for ROP and treatment-warranted ROP in infants born before 29 weeks' gestation.
- These findings underscore the importance of sepsis prevention and management in reducing the burden of ROP in extremely preterm infants.
- Further research into the mechanisms linking sepsis and ROP may inform targeted therapeutic strategies.
Importance:
Retinopathy of prematurity (ROP) is a major morbidity of preterm infants causing visual impairment, including blindness, for which timely treatment is vital and prevention is key. Increasing evidence suggests that exposure to neonatal sepsis contributes to ROP development.
Objective:
To investigate the association between neonatal sepsis and ROP in 2 large-scale cohorts of preterm infants born at less than 29 weeks' gestation.
Design, Setting, And Participants:
This retrospective cohort study was conducted using data from the German Neonatal Network (GNN) and Norwegian Neonatal Network (NNN). The GNN involves 68 and the NNN includes 21 level III neonatal intensive care units. Participants were infants born at a gestation of 22 weeks and 0 days to 28 weeks and 6 days and enrolled in the GNN between January 1, 2009, and December 31, 2022, and NNN between January 1, 2009, and December 31, 2018. Data were analyzed from February through September 2023.
Exposure:
Single or multiple episodes of culture-proven sepsis.
Main Outcomes And Measures:
Any ROP and treatment-warranted ROP.
Results:
Among 12 794 infants in the GNN (6043 female [47.2%] and 6751 male [52.8%]; mean [SD] gestational age, 26.4 [1.5] weeks) and 1844 infants in the NNN (866 female [47.0%] and 978 male [53.0%]; mean [SD] gestational age, 25.6 [1.5] weeks), the mean (SD) birth weight was 848 (229) g and 807 (215) g, respectively. Any ROP was present in 6370 infants (49.8%) in GNN and 620 infants (33.6%) in NNN, and treatment-warranted ROP was present in 840 infants (6.6%) in GNN and 140 infants (7.6%) in NNN. In both cohorts, there were increasing rates of treatment-warranted ROP with each sepsis episode (no sepsis: 572 of 10 658 infants [5.4%] in GNN and 85 of 1492 infants (5.7%) in NNN; 1 episode: 190 of 1738 infants in GNN [10.9%] and 29 of 293 infants [9.9%] in NNN; 2 episodes: 53 of 314 infants in GNN [16.9%] and 13 of 49 infants [26.5%] in NNN; 3 episodes: 25 of 84 infants [29.8%] in GNN and 3 of 10 infants [30.0%] in NNN). After adjusting for multiple confounders in the GNN dataset, the number of sepsis episodes was associated with ROP and treatment-warranted ROP compared with 0 episodes (1 episode: adjusted odds ratio [aOR], 1.44 [95% CI, 1.27-1.63]; P < .001 and OR, 1.60 [95% CI, 1.31-1.96]; P < .001, respectively; 2 episodes: OR, 1.81 [95% CI, 1.35-2.42]; P < .001 and OR, 2.38 [95% CI, 1.68-3.37]; P < .001, respectively; 3 episodes: OR, 4.39 [95% CI, 2.19-8.78]; P < .001 and OR, 3.88 [95% CI, 2.29-6.55]; P < .001, respectively). These associations were confirmed for any ROP by propensity score matching (for example, the aOR with propensity score matching was 1.76 [95% CI, 1.54-2.02]; P < .001 for 1 episode vs 0 episodes and 1.58 [95% CI, 1.12-2.22]; P = .007 for 3 episodes vs 0 or 1 episode). In the NNN dataset, surgical NEC was associated with treatment-warranted ROP (multivariable analysis: aOR, 3.37 [95% CI, 1.78-6.37]; P < .001).
Conclusions And Relevance:
This study found that in the large-scale GNN cohort, recurrent culture-proven sepsis was associated with ROP and treatment-warranted ROP in infants born at less than 29 weeks.
