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Association between Early Postnatal Hydrocortisone and Retinopathy of Prematurity in Extremely Preterm Infants
Mariya Petrishka-Lozenska1,2, Aldina Pivodic1,2, Anders Flisberg3,4
1The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Insights
Early low-dose hydrocortisone treatment for premature infants may significantly reduce the risk of retinopathy of prematurity (ROP) requiring treatment. This finding offers a potential strategy to prevent childhood blindness in extremely preterm babies.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Pediatric Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a primary cause of preventable blindness in children.
- Extremely preterm infants are at high risk for ROP and bronchopulmonary dysplasia (BPD).
- Early postnatal hydrocortisone is used to prevent BPD in preterm infants.
Purpose of the Study:
- To investigate the association between early low-dose intravenous hydrocortisone and ROP outcomes.
- To evaluate the efficacy of hydrocortisone in preventing ROP treatment in extremely preterm infants.
Main Methods:
- Retrospective cohort study of extremely preterm infants (born <28 weeks GA).
- Comparison of infants treated with low-dose hydrocortisone for BPD prevention versus untreated controls.
- Logistic regression and propensity score matching were used for analysis, adjusting for gestational age, birth weight, sex, and parenteral nutrition.
Main Results:
- Hydrocortisone treatment group showed a reduced incidence of ROP treatment (18.5% vs. 32.2%).
- Propensity score matching confirmed a lower risk of ROP treatment in the hydrocortisone group (OR: 0.38).
- Adjusted analysis revealed a persistent reduced risk of ROP treatment (OR: 0.31, p=0.0005).
Conclusions:
- Early postnatal low-dose intravenous hydrocortisone may decrease the need for ROP treatment.
- This intervention shows promise in reducing the severity of ROP in extremely preterm infants.
- Further research may confirm hydrocortisone as a protective strategy against ROP in this vulnerable population.
Introduction:
Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness. We investigated the association of early postnatal low-dose intravenous hydrocortisone used for the prevention of bronchopulmonary dysplasia (BPD) with ROP outcome among extremely preterm infants in a Swedish cohort.
Methods:
This retrospective cohort study included extremely preterm infants born before 28 weeks of gestational age (GA). Infants born September 2020-August 2022, treated with low-dose intravenous hydrocortisone for prevention of BPD, were compared to untreated controls born September 2016-August 2020. Hydrocortisone was administered postnatally with a dose of 0.5 mg/kg twice daily for 7 days, followed by 0.5 mg/kg per day for 3 days. Logistic regression, adjusted for GA, birth weight (BW), sex, and parenteral nutrition, was used in the primary analysis. For robustness, we performed 1:1 propensity score (PS) matching followed by logistic regression.
Results:
Of 245 preterm infants included, 65 were treated with low-dose hydrocortisone and 180 were untreated controls. Incidence of ROP treatment was reduced in the hydrocortisone group 18.5% (12/65) versus controls 32.2% (58/180), p = 0.038. One-to-one PS matching (n = 62 + 62) confirmed the reduced incidence of ROP treatment in the hydrocortisone-treated infants (odds ratio [OR]: 0.38, 95% confidence interval [95% CI]: 0.16-0.88, p = 0.025). After adjusting for GA, BW, sex, and parenteral nutrition ≥14 days, the reduced risk of ROP treatment after early hydrocortisone treatment persisted (OR: 0.31, 95% CI: 0.16-0.60, p = 0.0005).
Conclusion:
Early postnatal low-dose intravenous hydrocortisone used to prevent BPD may reduce the risk of ROP treatment among extremely preterm infants.
