Potential Role of Bilirubin in Preventing Retinopathy of Prematurity

Abstract

Background: One of the most common problems in preterm neonates is retinopathy of prematurity (ROP). It has been shown antioxidants may be effective in preventing development and progression of ROP. Considering the antioxidant properties of bilirubin, we decided to investigate the bilirubin level in neonates with ROP and compare it with healthy neonates. Methods: This case-control study was performed on VLBW neonates admitted to the NICU of Ghaem Hospital in Mashhad between 2014-2020 years for Jaundice evaluation. Complete neonate’s characteristics, maternal history and laboratory results were collected in a questionnaire. Then the neonates were examined for ROP by a fellowship of retina of ophthalmologist at 32 weeks or four weeks after birth. The highest bilirubin levels during their hospitalization were also recorded. Results: Of 427 neonates examined, 121 (37.7%) had normal eye examination and 266 (62.3%) had ROP. The mean weight, gestational age and bilirubin were 1455.8± 431.4 gram, 31.6± 2.3 weeks and 8.8 ± 2.4 mg / dl, respectively. There was a significant difference between controls and neonates with ROP with regard to birth weight, duration of intermittent positive pressure ventilation (IPPV), duration of oxygen therapy, first and fifth minute Apgar scores, maximum level of bilirubin and gestational age(P<0.05).It was observed that maximum level of bilirubin was lower in neonates with higher stages of ROP. Conclusion: According to the results of this study, higher levels of bilirubin in neonates may be a protective factor against ROP, Moreover, increased levels of bilirubin is associated with reduced severity of ROP .Therefore, prophylaxis phototherapy in premature infants may need to be reconsidered.

The incidence and risk factors associated with the retinopathy of prematurity in a tertiary hospital using 10-year retrospective data

“…The impact of bilirubin levels on the development of ROP has been the subject of debate in earlier publications. Higher levels of bilirubin in neonates may serve as a preventative measure against ROP, according to a recent case-control study [ 31 ]. Additionally, ROP is thought to be less severe when bilirubin levels are higher [ 31 ].…”

“…Higher levels of bilirubin in neonates may serve as a preventative measure against ROP, according to a recent case-control study [ 31 ]. Additionally, ROP is thought to be less severe when bilirubin levels are higher [ 31 ]. Dejonge revealed no significant difference in the average duration of phototherapy on ROP development but found an association between ROP development and bilirubin levels instead [ 32 ].…”

“Light” on Phototherapy—Complications and Strategies for Shortening Its Duration, A Review of the Literature

“…Interestingly, phototherapy may weaken the protective antioxidant effect of bilirubin on cell membranes, making them more susceptible to injury that could result in cell apoptosis. Boskabadi et al found that higher bilirubin levels in preterm newborns may act as a protective factor against ROP [33]. Phototherapy itself causes oxidative stress.…”

Insights into the liver-eyes connections, from epidemiological, mechanical studies to clinical translation

“…Recently, a Mendelian randomization case-control study reports that genetic variants within the CYP2R1 locus would reduce liver 25-hydroxylase activities and the resultant low blood levels of 25(OH)D are linked with increased non-infectious uveitis/scleritis risk at an OR = 6.42 [ 40 ]. Interestingly, excessive blood unbound bilirubin is suggested to be a protective factor in specific conditions, including in neonates to reduce the severity of retinopathy of prematurity (ROP) [ 41 ], and in patients with diabetic mellitus or impaired glucose tolerance to protect against DR [ 42 ].…”