Infantile hemangiomas and retinopathy of prematurity: clues to the regulation of vasculogenesis

Abstract

Retinopathy of prematurity (ROP) and infantile hemangiomas are vascular disorders that may share common mechanisms. This study examined a potential clinical association between these disorders in populations of preterm infants at two hospitals in the U.S. and Hungary. Clinically collected data from infants with gestational ages less than 32 weeks born between May 1, 2007 and December 31, 2010 seen in the University of Iowa Children’s Hospital or the Department of Obstetrics and Gynecology, University of Pécs, were abstracted from electronic medical records and entered into a study database. Demographic and clinical variables were examined as potential covariates to the disorders of interest. Data were initially analyzed by center and then combined through meta-analysis. Six hundred eighty-four subjects were studied, 236 from Pécs and 448 from Iowa. There were no significant demographic differences between populations. Univariate analysis on each study population yielded covariates to ROP in each population, including infantile hemangioma, which were entered into a logistic regression model. These models were combined through random effects meta-analysis and demonstrated a significant relationship between infantile hemangioma and ROP (odds ratio=1.84, 95% confidence interval 1.08–3.12). Conclusion Infantile hemangioma and ROP co-occur in premature infant populations. Further studies are needed to investigate the pathogenesis of both disorders.

Infantile Hemangiomas, Retinopathy of Prematurity and Cancer: A Common Pathogenetic Role of the β‐Adrenergic System

“…In addition, the association between segmental hemangiomas and arterial anomalies (usually ipsilateral to IHs), as observed in newborns with PHACE syndrome (a syndrome characterized by the association of posterior fossa brain anomalies, facial hemangiomas, arterial lesions, cardiac abnormalities/aortic coarctation, and eye abnormalities), indicates a relationship between regional hypoxia and IH development . That hypoxia is likely to play a central role in the pathogenesis of IHs is also suggested by the higher incidence of IHs in newborns with low birth weight due to placental insufficiency, the strong correlation of IHs with placental anomalies responsible of disturbances of the utero‐placental circulation, and the association between IHs and ROP, another disease characterized by an important hypoxic component . Together, these observations suggest that IHs are intrinsically hypoxic and that they may represent an attempt of revascularization in relatively hypoxic tissue areas …”

“…However, upon closer inspection, important similarities at multiple levels are also apparent. For instance, both IHs and ROP are typical of the neonatal age, and an association between the two diseases has been reported in the literature . Moreover, IHs, ROP, and cancer are all characterized by the presence of hypoxia‐induced angiogenesis.…”

Infantile Hemangiomas in Twins: A Prospective Cohort Study

“…Studies point to local or systemic hypoxia, which causes angiogenesis and vasculogenesis, as a possible triggering event and driver of hemangioma growth (4)(5)(6). Supportive clinical evidence includes the blanched skin precursors seen in many hemangiomas (suggesting local tissue hypoxia), the inverse relationship between birthweight and IHs, and the greater risk of retinopathy of prematurity in preterm infants with IHs than in those without (7,8). Based on these considerations and previous studies showing low birthweight as the most potent independent risk factor for IHs, we hypothesized that IHs would be more likely to occur in the smaller or sicker twin, in essence using twins as controls for one another (in twins who were discordant for the presence of hemangiomas) (9).…”

Az extrém alacsony születési súlyú koraszülöttek hyperglykaemiájának korai és késői szövődményei

“…Felmérések alapján a korai hyperglykaemia kiemelt rizikófaktor a ROP kialakulásában [7][8][9][10][11][12]. A koraszülöttséghez kapcsolódó szövődmények kockázatát jelentősen befolyásolhatja a hyperglykaemia.…”

“…Az extrém alacsony gesztációs korhoz társuló szövődmények kialakulását jelentősen befolyásolhatja a hyperglykaemia. Ok-okozati kapcsolatot igazoltak a hyperglykaemia jelenléte és a súlyos ROP kialakulása között [7][8][9][10][11][12]. Állatkísérletes vizsgálatokkal igazolták, hogy az újszülött állatokban előidézett hyperglykaemia a retinában a makrofág sejtek felszaporodásához vezetett, növelte a proinflammatoricus citokinek jelenlétét, a neuronok apoptózisát okozta, valamint gátolta az angiogenezist [22].…”