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Association between antenatal and postnatal steroids and retinopathy of prematurity
Farnaz Javadian1, Prakesh S Shah2, Wilma Hopman3
1Department of Ophthalmology, Queen's University, Kingston, Ontario, Canada.
Insights
Postnatal steroids (PNS) in preterm infants are linked to higher odds of severe retinopathy of prematurity (ROP). Closer ROP monitoring is advised for infants receiving PNS, though bias is possible.
Area of Science:
- Neonatal care
- Ophthalmology
- Pharmacology
Background:
- Steroid therapy is vital for preterm infants, impacting morbidity and mortality.
- Antenatal steroids (ANS) and postnatal steroids (PNS) show varied effects on retinopathy of prematurity (ROP).
- Understanding steroid impact on ROP is crucial for neonatal intensive care.
Purpose of the Study:
- To investigate the association between antenatal (ANS) and postnatal steroid (PNS) use and the development of ROP.
- To analyze ROP risk in Canadian neonates based on different steroid treatment regimens.
- To provide data for optimizing steroid treatment strategies in premature infants.
Main Methods:
- Utilized data from the Canadian Neonatal Network (CNN) database.
- Included 20,255 neonates admitted to level III NICUs with gestational age <31 weeks or <1,250 g.
- Employed conditional logistic regression to determine odds ratios for ROP development based on ANS and PNS exposure.
Main Results:
- Neonates receiving PNS only showed the highest odds of type 1 ROP (adjusted OR = 3.48).
- Infants receiving both ANS and PNS had increased odds of type 1 ROP (adjusted OR = 2.9).
- The reference group was neonates receiving ANS only.
Conclusions:
- Postnatal steroid (PNS) use is associated with an increased risk of type 1 or treated ROP.
- Suggests enhanced ROP surveillance for infants exposed to PNS.
- Confounding by indication bias warrants consideration in interpreting results.
Background:
Steroid treatment can be crucial in treating morbidity and reducing mortality in preterm infants. The literature describes differing effects of antenatal (ANS) versus postnatal steroids (PNS) in the development of retinopathy of prematurity (ROP). The purpose of this study was to investigate the relationship between steroid use and development of ROP in Canadian neonates.
Methods:
Data were obtained from the Canadian Neonatal Network (CNN), a national database of all 32 level III neonatal intensive care units (NICUs) in Canada. A total of 20,255 neonates met inclusion criteria, with admission to a CNN NICU under the gestational age of 31 weeks or <1,250 g, with ROP screening. Unadjusted and adjusted odds ratios based on confounders from conditional logistic regression were determined for the risk of developing any ROP, type 1 ROP, and non-type 1 ROP, depending on ANS and PNS use.
Results:
Using ANS only as the reference group, neonates receiving only PNS had the highest odds of type 1 ROP and ROP requiring intervention (adjusted OR = 2.68; 95% CI, 1.55-4.64), followed by neonates receiving both ANS and PNS with an adjusted odds ratio of 2.51 (95% CI, 1.49-4.25).
Conclusions:
Receipt of PNS was associated with type 1 or treated ROP, suggesting the need for closer monitoring for ROP; however, confounding by indication bias cannot be ruled out.
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