A Prospective Analysis of the Retinopathy of Prematurity Correlated with the Inflammatory Status of the Extremely Premature and Very Premature Neonates

Borțea, Claudia Ioana; Enatescu, I.; Dima, Mirabela; Pantea, Manuela; Iacob, Emil Radu; Dumitru, Cătălin; Popescu, Alexandra; Stoica, Florina; Heredea, Rodica; Iacob, Daniela

doi:10.3390/diagnostics13122105

Cited by 6 publications

(3 citation statements)

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“…46 Observational findings of higher incidences of ROP in infants with increased markers of inflammation, along with animal models suggest that inflammatory mediators are negatively associated with retinal vessel development in a direct or indirect way and may be associated with permanently compromised retinal function. [20][21][22][23][47][48][49][50][51] Inflammation-induced reactive oxygen species and oxidative stress, as well as inflammation-induced VEGF expression, microglia activation, and retinal ganglion cell death have been discussed as causative mechanisms. 39,44,47,48 In rat models, microglia-derived interleukin (IL)-1β was found to induce retinal ganglion cell death and breakdown of the blood-retina barrier, 47,52 while application of IL-1 receptor antagonists attenuated vasoobliteration.…”

Section: Discussionmentioning

confidence: 99%

“…Neonatal sepsis may modify the second phase of ROP characterized by hypoxia and compensatory growth factor–induced aberrant retinal vascularization or may contribute to the arrest of vascularization in phase 1 and pathological neovascularization in phase 2 . Observational findings of higher incidences of ROP in infants with increased markers of inflammation, along with animal models suggest that inflammatory mediators are negatively associated with retinal vessel development in a direct or indirect way and may be associated with permanently compromised retinal function . Inflammation-induced reactive oxygen species and oxidative stress, as well as inflammation-induced VEGF expression, microglia activation, and retinal ganglion cell death have been discussed as causative mechanisms .…”

Section: Discussionmentioning

confidence: 99%

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Neonatal Sepsis Episodes and Retinopathy of Prematurity in Very Preterm Infants

Glaser,

Härtel,

Klingenberg

et al. 2024

JAMA Netw Open

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ImportanceRetinopathy of prematurity (ROP) is a major morbidity of preterm infants causing visual impairment, including blindness, for which timely treatment is vital and prevention is key. Increasing evidence suggests that exposure to neonatal sepsis contributes to ROP development.ObjectiveTo investigate the association between neonatal sepsis and ROP in 2 large-scale cohorts of preterm infants born at less than 29 weeks’ gestation.Design, Setting, and ParticipantsThis retrospective cohort study was conducted using data from the German Neonatal Network (GNN) and Norwegian Neonatal Network (NNN). The GNN involves 68 and the NNN includes 21 level III neonatal intensive care units. Participants were infants born at a gestation of 22 weeks and 0 days to 28 weeks and 6 days and enrolled in the GNN between January 1, 2009, and December 31, 2022, and NNN between January 1, 2009, and December 31, 2018. Data were analyzed from February through September 2023.ExposureSingle or multiple episodes of culture-proven sepsis.Main Outcomes and MeasuresAny ROP and treatment-warranted ROP.ResultsAmong 12 794 infants in the GNN (6043 female [47.2%] and 6751 male [52.8%]; mean [SD] gestational age, 26.4 [1.5] weeks) and 1844 infants in the NNN (866 female [47.0%] and 978 male [53.0%]; mean [SD] gestational age, 25.6 [1.5] weeks), the mean (SD) birth weight was 848 (229) g and 807 (215) g, respectively. Any ROP was present in 6370 infants (49.8%) in GNN and 620 infants (33.6%) in NNN, and treatment-warranted ROP was present in 840 infants (6.6%) in GNN and 140 infants (7.6%) in NNN. In both cohorts, there were increasing rates of treatment-warranted ROP with each sepsis episode (no sepsis: 572 of 10 658 infants [5.4%] in GNN and 85 of 1492 infants (5.7%) in NNN; 1 episode: 190 of 1738 infants in GNN [10.9%] and 29 of 293 infants [9.9%] in NNN; 2 episodes: 53 of 314 infants in GNN [16.9%] and 13 of 49 infants [26.5%] in NNN; 3 episodes: 25 of 84 infants [29.8%] in GNN and 3 of 10 infants [30.0%] in NNN). After adjusting for multiple confounders in the GNN dataset, the number of sepsis episodes was associated with ROP and treatment-warranted ROP compared with 0 episodes (1 episode: adjusted odds ratio [aOR], 1.44 [95% CI, 1.27-1.63]; P &lt; .001 and OR, 1.60 [95% CI, 1.31-1.96]; P &lt; .001, respectively; 2 episodes: OR, 1.81 [95% CI, 1.35-2.42]; P &lt; .001 and OR, 2.38 [95% CI, 1.68-3.37]; P &lt; .001, respectively; 3 episodes: OR, 4.39 [95% CI, 2.19-8.78]; P &lt; .001 and OR, 3.88 [95% CI, 2.29-6.55]; P &lt; .001, respectively). These associations were confirmed for any ROP by propensity score matching (for example, the aOR with propensity score matching was 1.76 [95% CI, 1.54-2.02]; P &lt; .001 for 1 episode vs 0 episodes and 1.58 [95% CI, 1.12-2.22]; P = .007 for 3 episodes vs 0 or 1 episode). In the NNN dataset, surgical NEC was associated with treatment-warranted ROP (multivariable analysis: aOR, 3.37 [95% CI, 1.78-6.37]; P &lt; .001).Conclusions and RelevanceThis study found that in the large-scale GNN cohort, recurrent culture-proven sepsis was associated with ROP and treatment-warranted ROP in infants born at less than 29 weeks.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Neonatal Sepsis Episodes and Retinopathy of Prematurity in Very Preterm Infants

Glaser,

Härtel,

Klingenberg

et al. 2024

JAMA Netw Open

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“…This is consistent with the results of a previous study, which suggested that elevated cord plasma IL-6 levels may be used as an independent predictor of severe ROP and laser treatment ( 68 ). Elevated IL-6 is significantly associated with increased risk of developing stage ≥II ROP, suggesting its potential as a biomarker for ROP risk prediction ( 69 ). Preterm infants with ROP who require treatment exhibit significantly higher levels of IL-8 compared with those who do not require treatment.…”

Section: Effect Of Hematological Indicators On Ropmentioning

confidence: 99%

Progress in the study of association between hematological indicators and retinopathy of prematurity (Review)

Tang,

Zhang,

Zhang

et al. 2024

Biomed Rep

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Retinopathy of prematurity (ROP) is a retinopathy caused by abnormal proliferation of blood vessels in premature infants. It can lead to retinal detachment and, in severe cases, blindness, rendering ROP a critical condition. Advances in neonatal medicine have improved survival rates of low birth weight and low gestational age infants. However, this progress has also led to a rise in incidence of ROP. Currently, premature birth, low birth weight and high postpartum oxygen levels are independent risk factors for ROP. Other factors include mode of delivery, multiple births, anemia, blood transfusion, maternal pregnancy factors, neonatal bronchopulmonary dysplasia, use of surfactants, arterial ductus arteriosus and necrotizing enterocolitis. Laboratory indicators in premature infants such as platelet count, levels of blood glucose, inflammatory cells, lipid and hemoglobin and blood transfusion may also be associated with ROP. However, the etiology and pathogenesis of ROP are not fully understood. A number of factors may influence the onset and progression of ROP, including decreased platelet counts, decreased hemoglobin levels, increased white blood cell counts, increased blood glucose levels, and disorders of lipid metabolism. The present study reviewed the effects of platelet count, hemoglobin, blood glucose, inflammatory cells and factors, blood lipids, and plasma metabolic pathways on ROP.

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