Role of the haematological phenotype as a predictive biomarker of retinopathy of prematurity development

Abstract

Purpose: To evaluate haematological parameters as possible biomarkers of the development of retinopathy of prematurity (ROP). Methods: Multicenter, observational, and prospective study of preterm infants (PTI) from eight NICU, born in Portugal with gestational age (GA) < 32 weeks or birth weight (BW) <1500 g. ROP staging performed according to the International Classification of ROP (ICROP). Sociodemographic, clinical and laboratory data were collected from the first week of life. Complete blood count (CBC) was determined according to standardized methods. According to the maximum stage of ROP, PTI were divided into four groups: without ROP, ROP stage 1 (ROP‐1), ROP stage 2 (ROP‐2) and ROP stage 3 (ROP‐3). Statistical analysis was performed with the SPSS program with significant value for p < 0.05. Results: 455 PTI were included, GA average of 29.5 ± 2.3 weeks, BW average of 1165.7 ± 313.9 grams and 50.5% were female. In this study 37.8% of the PTI developed ROP: 20% had ROP‐1, 9.4% ROP‐2 and 8.4% ROP‐3. 4.6% of PTI received treatment: laser was performed in 12 PTI (2.6%), anti‐VEGF in 7 PTI (1.5%), anti‐VEGF and laser in 1 PTI (0.2%), and anti‐VEGF, laser, and surgery in 1 PTI (0.2%). ROP‐3 was significantly associated with lower GA (p = <0.001), BW (p < 0.001), erythrocytes (p < 0.001), haemoglobin (p < 0.001), haematocrit (p < 0.001), lymphocyte (p = 0.047) and lymphocyte to monocyte ratio (LMR) (p = 0.018) compared with the other groups. Neutrophils (p = 0.039) and neutrophil to lymphocyte ratio (NLR) (p < 0.001) were higher in ROP‐3. For PTI who did not develop ROP were observed, in relation with the other groups: higher mean corpuscular haemoglobin concentration (MCHC) (p < 0.001), platelets (p = 0.029) and plateletcrit (PCT) (p = 0.007) and lower red cell distribution width (RDW) (p = 0.015) and erythroblast (p < 0.001). Conclusions: This study shows that the increase in neutrophils, NLR, and RDW and the decrease in lymphocytes, LMR, erythrocytes, and platelets may constitute early and low‐cost predictive biomarkers of ROP development.