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Bilirubinemia and retinopathy of prematurity in infants ≤ 29 weeks' gestational age
Srujana Rallabandi1, Sanjiv B Amin2,3
1Division of Neonatology, Department of Pediatrics, University of California, San Francisco, CA, USA.
Insights
Higher bilirubin levels in premature infants may protect against severe retinopathy of prematurity (ROP). This study found bilirubinemia associated with less severe ROP outcomes in extremely preterm infants.
Area of Science:
- Neonatalogy
- Ophthalmology
- Biochemistry
Background:
- Retinopathy of prematurity (ROP) is an oxidative stress-mediated condition affecting premature infants.
- Bilirubin is a known antioxidant, but its role in ROP is debated.
- Previous studies on bilirubinemia and ROP have yielded conflicting results.
Purpose of the Study:
- To investigate the association between bilirubinemia and the incidence and severity of ROP in extremely preterm infants.
- To determine if bilirubin levels correlate with oxidative stress markers in ROP development.
Main Methods:
- A prospective study included infants born at ≤29 weeks gestational age and birth weights ≤1000g.
- Total serum bilirubin (TSB) levels were monitored frequently during the first two weeks of life.
- Peak and mean TSB levels were analyzed against ROP incidence and severity.
Main Results:
- Of 193 infants, 110 developed ROP.
- Mean TSB levels were significantly associated with ROP severity (AOR 0.68, p=0.04).
- Peak TSB levels were also associated with ROP severity (AOR 0.71, p=0.02), but not incidence.
Conclusions:
- Bilirubinemia may offer protection against the severity of retinopathy of prematurity.
- Elevated bilirubin levels could be a protective factor in extremely preterm infants.
- Further research may explore bilirubin's therapeutic potential in managing ROP.
Background:
Bilirubin is a known antioxidant. We hypothesized that the degree of bilirubinemia is inversely associated with oxidative stress-mediated retinopathy of prematurity (ROP).
Methods:
A prospective study was performed to determine if bilirubinemia is associated with ROP in infants ≤ 29 wks' gestational age and birth weights ≤ 1000 g. Total serum bilirubin (TSB) levels were measured at least twice daily during the first week and at least daily during the second week to determine peak and mean TSB levels. The outcomes were the incidence and severity of ROP.
Results:
Of 193 infants studied, 110 developed ROP: 53 had mild (stage 1 in zone 2 or 3); 31 had moderate (stage 2 in zone 2 or 3); and 26 had severe ROP ( ≥ stage 3 in any zone or any stage in zone 1). Mean TSB levels were associated with the severity (adjusted odds ratio [AOR] 0.68, 95% confidence interval [CI]:0.47-0.98, p = 0.04), but not with the incidence of ROP (AOR 0.81, 95% CI:0.52-1.27, p = 0.3). Peak TSB levels were also associated with the severity (AOR 0.71, 95% CI:0.52-0.96, p = 0.02), but not with the incidence of ROP (AOR 0.71, 95% CI:0.48-1.01, p = 0.07).
Conclusions:
Bilirubinemia may be protective against severity of ROP.
Impact:
Retinopathy of prematurity (ROP) is a disease mediated by oxidative stress. Increasing antioxidant status may decrease the incidence and severity of ROP. Bilirubin is a known antioxidant; however, findings from observational studies evaluating the role of bilirubinemia against the incidence and/or severity of ROP in premature infants are conflicting. Our findings from this prospective study suggests that bilirubinemia may be protective against the severity of ROP.
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