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Risk factors for severe retinopathy of prematurity: A retrospective case-control study
Qingmin Ma1, Xi Lv1, Jiangya Wang2
1Department of Ophthalmology, Hebei General Hospital, Shijiazhuang, Hebei 050051, P.R. China.
Insights
Gestational age is the primary predictor of severe retinopathy of prematurity (ROP) in preterm infants. Infants born at or before 30.5 weeks have a significantly higher risk, alongside perinatal complications and lower lymphocyte-to-monocyte ratio (LMR).
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Perinatal Research
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Early identification of infants at high risk for severe ROP is crucial for timely intervention and prevention of vision loss.
- Existing risk stratification models require further refinement with the inclusion of novel biomarkers.
Purpose of the Study:
- To identify independent risk factors for severe retinopathy of prematurity (ROP) in preterm infants.
- To discover predictive biomarkers for early risk stratification of severe ROP.
- To evaluate the association of perinatal complications and hematological parameters with severe ROP.
Main Methods:
- Retrospective case-control study of preterm infants undergoing ROP screening.
- Stratification into mild and severe ROP groups based on clinical criteria.
- Analysis of demographic data, perinatal complications, maternal lipids, and serial hematological parameters (including lymphocyte-to-monocyte ratio [LMR]).
- Binary logistic regression and Receiver Operating Characteristic (ROC) curve analysis were employed.
Main Results:
- Lower gestational age, birth weight, and 1-min Apgar scores were associated with severe ROP.
- Significant risk factors included bronchopulmonary dysplasia, respiratory distress syndrome, sepsis, and need for blood transfusion.
- Severe ROP group exhibited significantly lower LMR within 24 hours of birth and at 1 week of age.
- Gestational age ≤30.5 weeks was identified as the sole independent predictor of severe ROP (sensitivity 76.2%, specificity 71.1%).
Conclusions:
- Gestational age is the most critical independent predictor for severe ROP, with infants born at ≤30.5 weeks at highest risk.
- Perinatal complications and reduced LMR (indicating altered inflammatory status) are significant contributing factors to severe ROP.
- Findings support enhanced surveillance for high-risk preterm infants and suggest LMR as a potential biomarker for ROP risk stratification.
Abstract:
The present study aimed to investigate the risk factors associated with severe retinopathy of prematurity (ROP) in preterm infants and to identify predictive biomarkers for early risk stratification. The present retrospective case-control study analyzed preterm infants who underwent ROP screening at Hebei General Hospital (Shijiazhuang, China) between September 2018 and July 2023. Participants were stratified into mild (n=42) and severe ROP (n=38) groups based on fundus examination results and treatment requirements. Demographic characteristics, perinatal complications, maternal third-trimester lipid profiles and serial hematological parameters (within 24 h of birth and at 1 week of age) were analyzed. Binary logistic regression analysis was performed to identify independent risk factors, and receiver operating characteristic (ROC) curves were constructed to evaluate predictive performance. Significant differences were observed between severe and mild ROP groups in gestational age, birth weight and 1-min Apgar score (all P<0.001). Perinatal complications significantly associated with severe ROP included neonatal bronchopulmonary dysplasia (P<0.001), neonatal respiratory distress syndrome (P=0.003), neonatal sepsis (P=0.009) and blood transfusion requirements (P<0.001). Among hematological parameters, lymphocyte-to-monocyte ratio (LMR) was significantly lower in the severe ROP group both within 24 h of birth (P=0.015) and at 1 week of age (P=0.01). Multivariate logistic regression identified gestational age as the sole independent risk factor for severe ROP (P<0.001). ROC curve analysis revealed that gestational age ≤30.5 weeks predicted severe ROP with 76.2% sensitivity and 71.1% specificity (P<0.001). Maternal third-trimester lipid parameters showed no significant associations with severe ROP development. In conclusion, gestational age represents the most significant independent predictor of severe ROP in preterm infants, with infants born at ≤30.5 weeks showing significantly increased risk. Additional risk factors include major perinatal complications and altered inflammatory profiles characterized by reduced LMR. These findings support enhanced surveillance protocols for preterm infants and suggest the potential utility of inflammatory biomarkers in ROP risk stratification strategies.
