Incidence and risk factors for retinopathy of prematurity in premature, extremely low birth weight and extremely low gestational age infants

Abstract

Background The aim of the study was to determine the incidence and risk factors of retinopathy of prematurity (ROP) in premature, extremely low birth weight (BW, ELBW) and extremely low gestational age (GA, ELGA) infants. Methods The medical records of preterm infants who were screened for ROP between January 2012 and December 2020 were retrospectively reviewed. Only one eye of each infant with higher grade ROP was included in the study. BW; GA; medical characteristics; the presence, severity, and need for treatment of ROP were recorded. Infants were divided into groups according to BW (≤1000 g, 1001-1750 g, > 1750 g) and GA (≤25w, 26-28w, 29-31w, 32-34w, ≥35w) and data were analyzed. Results Data of 2186 infants were evaluated. The overall incidences of any stage ROP and ROP requiring treatment were 43.5 and 8.0%, respectively. These rates were 81.1 and 23.9% in ELBW (≤1000 g) infants and were 92.9 and 64.3% in ELGA (≤25w) infants, respectively. The rates of ROP, the median duration of oxygen therapy and systemic diseases increased significantly as BW and GA decreased. The median duration of oxygen therapy and the rates of sepsis, pulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) were statistically higher in infants with ROP compared to those without ROP (p < 0.001). Multivariate regression analysis demonstrated that low BW and GA; prolonged duration of oxygen therapy; presence of PDA and necrotizing enterocolitis (NEC) were important risk factors for ROP. Conclusions ELBW and ELGA infants develop higher rates of ROP and severe ROP. Prolonged duration of oxygen therapy, the presence of concomitant neonatal sepsis, BPD, IVH, PDA, and NEC further increases the risk of ROP.

Preterm birth characteristics and outcomes in Portugal, between 2010 and 2018—A cross‐sectional sequential study

“…In medical literature, the reported rate of ROP is higher 32 , 33 than the one reported in this analysis, respectively, 43.5%–60% and 21.7%. It is unlikely that such a wide gap corresponds to decreased rate of disease but is more likely related to coding ROP practices; however, further analysis is required.…”

“…30 In our analysis, 13.0% of extreme preterms developed severe IVH (Grades 3 and 4) in keeping with literature reports of 14.3%. 31 In medical literature, the reported rate of ROP is higher 32,33 than the one reported in this analysis, respectively, 43.5%-60% and 21.7%. It is unlikely that such a wide gap corresponds to decreased rate of disease but is more likely related to coding ROP practices;…”

Systemic Cytokines in Retinopathy of Prematurity

“…IVH is a serious complication in preterm infants, and its association with ROP has been demonstrated in various studies [ 254 , 274 , 275 , 276 , 277 , 278 , 279 ]. IVH usually occurs within the first week of life, causing poor development of neurons and glial cells [ 280 ].…”

“…Clinically, BPD is defined as the need for supplemental oxygen either at 4 weeks postnatal age or 36 weeks PMA [ 293 ], although lung injury commences soon after birth [ 294 ]. BPD is characterized by chronic lung disease mainly due to prolonged application of mechanical ventilation and oxygen toxicity after birth [ 294 ] and is identified as an independent risk factor for ROP [ 27 , 279 , 295 ]. In spite of the contribution from exposure to a high-oxygen environment, cytokines level alternation in BPD patients was described in several studies and may also play a role in the pathogenesis of ROP.…”

“…Sepsis, which may develop at any time in the neonatal period, is a well-known independent risk factor for ROP [ 236 , 279 , 324 , 325 ]. The resultant hemodynamic instability causes fluctuation in blood oxygen saturation, which might lead to retinal ischemia [ 326 ].…”