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Structural Equation Modelling of Retinopathy of Prematurity Treatment Integrating Both Physical and Clinical Effects
José Luis García-Serrano1,2, Olena Protsyk3, Teresa Domech-Serrano2
1Department of Surgery and Related Specialties, University of Granada, 18012 Granada, Spain.
Insights
Infants with lower gestational age, birth weight, and conditions like sepsis require retinopathy of prematurity (ROP) treatment. These factors increase ROP risk through retinal avascularity and prolonged ventilation.
Area of Science:
- Ophthalmology
- Neonatology
- Medical Informatics
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Identifying risk factors for ROP requiring treatment is crucial for early intervention.
- Previous studies have explored various risk factors, but a comprehensive model is needed.
Purpose of the Study:
- To develop a structural equation model (SEM) to identify physical and clinical risk factors for retinopathy of prematurity (ROP) requiring treatment.
- To elucidate the relationships between early life factors and the development of ROP needing intervention.
Main Methods:
- Retrospective, observational, case-control study of 314 infants screened for ROP.
- Utilized bivariate binary logistic regression, decision tree analysis, and structural equation modeling (SEM).
Main Results:
- SEM identified retinal avascular area, vascularization rate, and duration of intubation as key factors for ROP treatment.
- Lower gestational age and birth weight correlated with increased retinal avascular area.
- Sepsis, ductus arteriosus, and transfusion needs were associated with longer intubation and mechanical ventilation.
Conclusions:
- Lower gestational age, birth weight, sepsis, ductus arteriosus, transfusion, and poor weight gain increase the risk of ROP requiring treatment.
- These risks are mediated by increased retinal avascular area, slower vascularization, and prolonged mechanical ventilation.
- The SEM provides a framework for understanding the complex interplay of factors leading to ROP treatment needs.
Abstract:
Background: We sought to develop a structural equation model (SEM) identifying physical and clinical risk factors associated with treatment for retinopathy of prematurity (ROP). Methods: This retrospective, observational, case-control study included 314 infants screened for ROP between April 2004 and July 2024. A bivariate binary logistic regression model, decision tree, and structural equation model (SEM) were employed to develop a more general model for ROP requiring treatment. Results: In the SEM, the factors significantly associated with ROP treatment included the retinal avascular area according to disk diameter (DD) (p < 0.001), weekly vascularisation rate (DD/w) (p < 0.001), and duration of intubation (days) (p < 0.001). In addition, the following significant associations were identified in both the bivariate analysis and the SEM: lower gestational age (p < 0.001) and birth weight (p <0.001) were associated with greater retinal avascular area; low postnatal weight gain (p < 0.027) was associated with a slow rate of retinal vascularisation; sepsis (p < 0.001), ductus arteriosus (p < 0.001), and the need for transfusion (p < 0.001) were associated with longer intubation mechanical ventilation (IMV). Conclusions: Lower gestational age, lower birth weight, sepsis, ductus arteriosus, transfusion, and lower weight gain increase the risk of requiring ROP treatment. In the SEM, this association is represented through three intermediate physical endogenous variables, namely, the greater temporal avascular area of the retina, the lower postnatal vascularisation rate, and the greater duration of IMV.
