Erythrocyte transfusions are associated with retinopathy of prematurity in extremely low gestational age newborns

Glaser, Kirsten; Härtel, Christoph; Dammann, Olaf; Herting, Egbert; Andres, Oliver; Speer, Christian P.; Göpel, Wolfgang; Stahl, Andreas; ,

doi:10.1111/apa.16965

Cited by 12 publications

(3 citation statements)

References 31 publications

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“…Addressing these concerns, we controlled for several known and probable prenatal, perinatal, and infant risk factors, including NEC requiring surgery and RBC transfusions, which were also associated with ROP and treatment-warranted ROP. The latter findings are in keeping with previous investigations of our group and other cohort and network studies describing RBC transfusions and the concomitant fetal hemoglobin reduction as an independent risk factor associated with ROP and progression to higher-stage disease . On the contrary, our analyses confirmed previous findings of protective associations of antenatal steroids with ROP development .…”

Section: Discussionsupporting

confidence: 82%

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: Discussionsupporting

confidence: 82%

Neonatal Sepsis Episodes and Retinopathy of Prematurity in Very Preterm Infants

Glaser,

Härtel,

Klingenberg

et al. 2024

JAMA Netw Open

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“…With great interest we read the article by Glaser et al regarding the risk of retinopathy of prematurity (ROP) in neonates with history of red blood cell (RBC) transfusions. 1 The authors reported increased odds of ROP in neonates who received more than two RBC units (aOR 1.2; 95% CI 1.0─1.3), while decreased odds of ROP were reported in neonates with less than two RBC units (aOR 0.7; 95% CI 0.6─0.7). This study provides important data in a large cohort (n = 12 565).…”

Section: Dear Editormentioning

confidence: 95%

Erythrocyte transfusions and retinopathy of prematurity: Plea for application of the two‐phase theory

El Emrani,

van der Meeren,

Lopriore

et al. 2023

Acta Paediatrica

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“…Glaser et al. 's 7 study of 12 565 German infants from 68 neonatal intensive care units found that red blood cell transfusions were associated with an increased risk of retinopathy of prematurity (ROP) in neonates born at an extremely low gestational age. Meanwhile, Denier et al 8 .…”

Section: Erythrocyte Transfusions Were Associated With Retinopathy Of...mentioning

confidence: 99%