Perinatal growth characteristics and associated risk of developing threshold retinopathy of prematurity

doi:10.1016/S1091-8531(02)42015-0

Journal of American Association for Pediatric Ophthalmology and Strabismus

Volume 7, Issue 1, February 2003, Pages 34-37

https://doi.org/10.1016/S1091-8531(02)42015-0 Get rights and content

Abstract

Purpose

To document perinatal growth characteristics in infants who developed threshold retinopathy of prematurity (ROP) in an attempt to describe prenatal and postnatal growth-related risk factors for threshold ROP.

Methods

To document birth weight as well as absolute and relative weight gain (g/d and g/kg/d) in the first 6 weeks of life in infants who developed threshold ROP and who were admitted to a single tertiary neonatal intensive care unit between 1996 and 2000. These data were compared (case-control approach) with infants of the same gestational age (GA) who did not developed threshold ROP.

Results

Small for gestational age (SGA; ie, weight <10th percentile for a given GA) and growth restriction (<25th percentile for a given GA) are risk factors for threshold ROP (relative risk = 3.7 and 4.5, respectively). Absolute weight gain (g/d) is also associated with an increased risk of developing threshold ROP (P<.05). In contrast, relative weight gain (g/kg/d) is not significantly different between threshold ROP infants and GA-matched controls.

Conclusions

SGA and a birth weight below the 25^th percentile are risk factors for threshold ROP. Postnatal weight and absolute weight gain (g and g/d, respectively) in the first 6 weeks of life are statistically significant but of less clinical relevance because smaller infants at birth stay relatively smaller during the first 6 weeks of life. Even with normal (ie, same weight as control infants) postnatal relative weight gain (g/kg/d), growth retarded or restricted infants at birth still have an increased risk of developing threshold ROP.

Section snippets

Materials and methods

The Neonatal Intensive Care Unit of the University Hospitals in Leuven, Belgium, serves as a tertiary neonatal intensive and high-care unit with a capacity of 35 beds within a structured regional perinatal referral center. During the period studied (1996 to 2000), screening for retinopathy was performed in all infants with a gestational age (GA) at birth <35 weeks or birth weight < 2,000g. The first examination was performed at the postnatal age of 4 weeks. Follow-up was continued at least

Results

Retinopathy (any stage below threshold ROP) could be documented in 16 of 31 (52 %) of control infants, and six of these infants developed grade 3 retinopathy. Mean birth weight in threshold ROP infants was 760 g (SD = 181g). In GA-matched controls, mean birth weight was 906 g (SD = 240g) (P < .02). SGA (<10th percentile) and growth restriction (<25^th percentile) were documented in 11 (35%) and 19 (65%) of infants, respectively, who developed threshold ROP. In the control group, a normal

Discussion

According to the results of this study, small for gestational age (<10^th percentile) and growth restriction (<25^th percentile) at birth are risk factors of developing threshold retinopathy. Bardin,12 highlights that in infants younger than 27 weeks, the higher risk of developing retinopathy in preterm infants who are also small for gestational age. Moreover, in most epidemiological studies, the association between birth weight and retinopathy is stronger than the association between GA and

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Cited by (73)

New evidence on the protector effect of weight gain in retinopathy of prematurity
2021, Anales de Pediatria
La retinopatía del prematuro (ROP) se caracteriza por el desarrollo vascular insuficiente en la retina que, en los casos severos precisa tratamiento precoz para evitar secuelas visuales. Es actualmente la segunda causa mundial de ceguera infantil prevenible.
Estudio observacional, retrospectivo, de casos-controles sobre 233 recién nacidos prematuros explorados entre 1999-2019.
La ganancia de peso posnatal en las primeras 4 semanas, el peso al nacer, la edad gestacional, la ventilación mecánica, las transfusiones recibidas y la presencia de sepsis, ductus arteriovenoso persistente, enterocolitis necrosante, hemorragia intraventricular o leucomalacia periventricular, mostraron diferencias significativas entre el grupo de ROP no susceptible de tratamiento frente al grupo candidato a tratamiento. La ganancia ponderal media fue 12,75 ± 5,99 g/día en el grupo no susceptible de tratamiento y 9,50 ± 5,45 g/día en el susceptible de tratamiento. El riesgo de ROP candidata a tratamiento se redujo progresivamente con el aumento de ganancia ponderal. La reducción del riesgo fue de 2,76 - 8,35% en ganancias de 10 g/día, y alcanza el 7,17 - 12,76% en ganancias de 20 g/día.
El riesgo de presentar ROP severa candidata a tratamiento disminuye con el aumento de la ganancia de peso posnatal en las primeras 4 semanas. Esta relación se mantiene en ganancias de peso > 14 g/día. Sin embargo, se deben tener en cuenta la edad gestacional y peso al nacer del recién nacido, la duración de la ventilación mecánica y su comorbilidad para la evaluación global del riesgo de ROP que precisa tratamiento.
Retinopathy of prematurity (ROP) is characterised by insufficient vascular development in the retina, and requires early treatment to avoid visual disability in severe cases. ROP is currently the second leading cause of preventable child blindness in the world.
This was an observational, retrospective, case-control study including 233 preterm infants examined between 1999 and 2019.
Postnatal weight gain in the first 4 weeks of life, birth weight, gestational age, mechanical ventilation, transfusion, presence of sepsis, persistence of arterial ductus, necrotising enterocolitis, intraventricular haemorrhage, or periventricular leukomalacia were found to be significantly different between the ROP groups requiring and not requiring treatment. The mean postnatal weight gain in the ROP group not requiring treatment was 12.75 ± 5.99 g/day, whereas it was 9.50 ± 5.45 g/day in the ROP group requiring treatment. The risk of developing ROP that required treatment decreased with an increase in weight gain. The risk reduction was 2.76 - 8.35% in preterm infants gaining 10 g/day, and 7.17 - 12.76% in infants gaining 20 g/day.
The risk of developing ROP requiring treatment decreased with increasing weight gain in the first 4 weeks of life. This was applicable in infants with postnatal weight gain ≥ 14 g/day. However, gestational age, birth weight, time of mechanical ventilation, and comorbidity should be taken into account when evaluating the risk of ROP requiring treatment.
Screening for retinopathy of prematurity by telemedicine in a tertiary level neonatal intensive care unit in France: Review of a six-year period
2018, Journal Francais d'Ophtalmologie
Citation Excerpt :
Since a few years, the use of digital imaging in ROP screening permit to establish precise diagnoses and monitoring of ROP. Low gestational age (GA), low birth weight (BW) and prolonged exposure to supplementary oxygen are major proven risk factors for ROP [3,4]. Oxygen administration is better controlled nowadays than in the past in developed countries, but ROP persists, partly because of the increased survival of infants with extremely low GA and BW.
To analyze the prevalence and risk factors for retinopathy of prematurity (ROP) and severe (treatment-requiring) ROP.
A retrospective study was conducted in a level III neonatal unit in Bordeaux, France, from 2009 to 2015. Four hundred and nineteen preterm infants who were screened for ROP exclusively by RetCam were included.
ROP of any degree was diagnosed in 27.68% of infants. Stages 1, 2, 3 and 4 ROP was found in 44%, 46%, 9% and 1% of subjects, respectively. No stage 5 ROP was observed. 28/419 infants (6.6%) were treated exclusively with laser photocoagulation. No intravitreal anti-VEGF injections or surgical treatments were performed. No infants born at > 31 weeks or with BW > 1110 g required ROP treatment. On multivariate analysis, risk factors for ROP development were low birth weight, low gestational age at birth, high duration of invasive mechanical ventilation, shock or use of vasopressors. On multivariate analysis, risk factors for severe, treatment-requiring ROP were male gender, gestational age ≤ 27 weeks and Apgar score at 5 minutes ≤ 7.
In our 6-year series, ROP was successfully identified on screening exclusively by telemedicine, and no surgical treatment was required. This study identifies known ROP risk factors, but the Apgar score at 5 minutes as a risk factor for severe ROP requires further studies in order to be confirmed.
Analyser la prévalence et les facteurs de risques de rétinopathie du prématuré (ROP) et de ROP sévère (nécessitant un traitement).
Une étude rétrospective a été menée dans une maternité de niveau 3 à Bordeaux, de 2009 à 2015. Quatre cent dix-neuf nourrissons prématurés dont la ROP a été dépistée exclusivement avec la RetCam ont été inclus.
Une ROP a été retrouvée chez 27,68 % des nourrissons. Une ROP de stades 1, 2, 3 et 4 a été retrouvée dans 44 %, 46 %, 9 % et 1 % des sujets, respectivement. Il n’y avait pas de ROP de stade 5. Au total, 6,6 % des nourrissons (28/419) ont été traités par photocoagulation laser exclusive. Aucune injection intra-vitréenne d’anti-VEGF ou de traitement chirurgical n’ont été réalisés. Aucun nourrisson dont le terme était > 31 SA ou de poids de naissance > 1110 g n’a nécessité de traitement. En analyse multivariée, les facteurs de risques de développer une ROP étaient un faible poids de naissance, un faible âge gestationnel à la naissance, la durée de ventilation mécanique invasive et un état de choc ou l’utilisation d’amines vasopressives. En analyse multivariée, les facteurs de risques de ROP sévère étaient le sexe masculin, le terme ≤ 27 SA et le score d’Apgar à 5 minutes ≤ 7.
Dans notre série sur 6 ans, la ROP a été dépistée avec succès par télémédecine exclusive et aucun traitement chirurgical n’a été nécessaire. Cette étude retrouve les facteurs de risques connus de ROP mais le score d’Apgar à 5 minutes comme facteur de risque de ROP sévère nécessite des études ultérieures avant d’être confirmé.
Importance of birth weight as a risk factor for severe retinopathy of prematurity when gestational age is 30 or more weeks
2014, American Journal of Ophthalmology
Citation Excerpt :
There are prior reports that advocate limiting the scope of ROP screening.11,12 Some studies13–15 have scrutinized postnatal factors, such as weight gain, as predictors of the risk of developing severe ROP. We did not attempt to address these questions within our limited sample.
To determine whether birth weight less than 1500 g is a relevant guideline indicating the need for examination for retinopathy of prematurity (ROP) when gestational age at birth is 30 or more completed weeks.
A retrospective observational cohort study.
A total of 266 infants in a single institutional neonatal intensive care unit (NICU), whose gestational age at birth was 30 or more weeks but whose birth weight was less than 1500 g, were examined according to published guidelines. Infants with lethal congenital anomalies or major ocular abnormalities were excluded. Outcomes were vascularization in retinal zone III without a prior need for treatment, or ROP warranting treatment.
A study outcome was reached by 212 infants. Two hundred and eleven (99.5%) became vascularized through zone III without needing treatment. Only 1 (0.5%) required treatment for ROP. The 95% confidence interval for the occurrence rate of ROP requiring treatment in this cohort was 0.01%-2.60%.
Our results suggest that the occurrence rates of ROP requiring treatment in infants with gestational age 30 or more weeks and birth weight less than 1500 g is very low, and could indicate the need to revise examination guidelines for this subgroup of infants.
Characteristics of posterior zone I retinopathy of prematurity
2023, Eye (Basingstoke)
Retinopathy of Prematurity in Zone I posterior (Zone Half): Neonatal Profile, Clinical characteristics, and outcomes
2022, Research Square
Development and Validation of a Deep Learning Model to Predict the Occurrence and Severity of Retinopathy of Prematurity
2022, JAMA Network Open

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^☆: Research of GN supported by FWO Clinical Doctoral Grant A 6/5-CM. D 11.354.

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Regular articlePerinatal growth characteristics and associated risk of developing threshold retinopathy of prematurity☆

Abstract

Purpose

Methods

Results

Conclusions

Section snippets

Materials and methods

Results

Discussion

J AAPOS

Ophthalmology

J AAPOS

J Pediatr

J Pediatr

J AAPOS

Curr Eye Res

The EPICure Study: outcomes to discharge from hospital infants born at the threshold of viability

Pediatrics

Current incidence of retinopathy of prematurity, 1989-1997

Pediatrics

Regular article
Perinatal growth characteristics and associated risk of developing threshold retinopathy of prematurity☆