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Risk factors for the time to development of retinopathy of prematurity in premature infants in Iran: a machine
Leili Tapak1, Leila Nezamabadi Farahani2, Naeeme Taslimi Taleghani3
1Department of Biostatistics, School of Public Health and Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Insights
Key risk factors for retinopathy of prematurity (ROP) include ventilation duration, gestational age, and oxygen exposure. Early screening and understanding nonlinear relationships are crucial for managing this leading cause of infant blindness.
Area of Science:
- Neonatal ophthalmology
- Pediatric critical care
Background:
- Retinopathy of prematurity (ROP) is a significant cause of preventable infant blindness.
- Abnormal blood vessel growth in the immature retina characterizes ROP.
- Identified risk factors for ROP development remain debated.
Purpose of the Study:
- To identify risk factors influencing the time to ROP development in Iranian infants.
- To analyze multifactorial elements contributing to ROP onset.
Main Methods:
- A historical cohort study analyzed hospital records of 338 newborns from 2017-2021.
- Included preterm infants (BW ≤ 2000g or GA < 34 wk) and high-risk infants.
- Random survival forest analysis was employed to determine predictors of ROP development time.
Main Results:
- Significant predictors included duration of ventilation, gestational age (GA), oxygen supplementation, and bilirubin levels.
- Other key factors identified were antibiotic and TPN duration, mother's age, birth order, surfactant administration, and screening timeliness.
- The model achieved a concordance index of 0.878 for survival prediction.
Conclusions:
- Duration of ventilation, GA, oxygen, bilirubin, antibiotic/TPN duration, maternal age, birth order, surfactant use, and screening are potential ROP prognostic factors.
- The relationships between these risk factors and ROP development are often nonlinear.
- Clinical management and early intervention strategies should consider these complex, nonlinear associations.
Background:
Retinopathy of prematurity (ROP), is a preventable leading cause of blindness in infants and is a condition in which the immature retina experiences abnormal blood vessel growth. The development of ROP is multifactorial; nevertheless, the risk factors are controversial. This study aimed to identify risk factors of time to development of ROP in Iran.
Methods:
This historical cohort study utilized data from the hospital records of all newborns referred to the ROP department of Farabi Hospital (from 2017 to 2021) and the NICU records of infants referred from Mahdieh Hospital to Farabi Hospital. Preterm infants with birth weight (BW) ≤ 2000 g or gestational age (GA) < 34 wk, as well as selected infants with an unstable clinical course, as determined by their pediatricians or neonatologists, with BW > 2000 g or GA ≥ 34 wk. The outcome variable was the time to development of ROP (in weeks). Random survival forest was used to analyze the data.
Results:
A total of 338 cases, including 676 eyes, were evaluated. The mean GA and BW of the study group were 31.59 ± 2.39 weeks and 1656.72 ± 453.80 g, respectively. According to the criteria of minimal depth and variable importance, the most significant predictors of the time to development of ROP were duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of Total Parenteral Nutrition (TPN), mother age, birth order, number of surfactant administration, and on time screening. The concordance index for predicting survival of the fitted model was 0.878.
Conclusion:
Our findings indicated that the duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of TPN, mother age, birth order, number of surfactant administrations, and on time screening are potential risk factors of prognosis of ROP. The associations between identified risk factors were mostly nonlinear. Therefore, it is recommended to consider the nature of these relationships in managing treatment and designing early interventions.
