Poor postnatal weight gain: A risk factor for severe retinopathy of prematurity

doi:10.1067/mpa.2000.110342

Journal of American Association for Pediatric Ophthalmology and Strabismus

Volume 4, Issue 6, December 2000, Pages 343-347

https://doi.org/10.1067/mpa.2000.110342 Get rights and content

Abstract

Purpose: This study aimed to investigate the relationship between rate of postnatal weight gain and severity of retinopathy of prematurity (ROP). Methods: All infants (n = 111) screened for ROP at a single tertiary intensive care nursery over a 2-year period with an estimated gestational age of 30 weeks or less and follow-up to at least 42 weeks' postconception were included. The authors performed a retrospective review of records and statistical analysis of risk factors for ROP using multivariate analysis. Results: Infants with severe (stage 3 or greater) ROP gained an average 10.9 g/kg per day in the first 6 weeks of life, compared to a mean of 9.6 g/kg per day for those with mild or no ROP (P =.04). By multiple regression, which included birth weight, gestational age, and 9 other reported risk factors, there was an association between rate of postnatal weight gain and severity of ROP (P =.02). By stepwise regression, 4 variables were associated with ROP severity: estimated gestational age at birth (P =.002), rate of postnatal weight gain (P =.0002), volume of transfused erythrocytes (P =.0001), and culture-proven sepsis (P =.02). Conclusion: Poor postnatal weight gain is a risk factor for the development of severe (stage 3 or greater) ROP. Ophthalmologists should take note of those infants who gain less than 50% of their birth weight in the first 6 weeks of life. (J AAPOS 2000;4:343-7)

Section snippets

Subjects and methods

A retrospective review of records was performed of all infants screened for ROP over a 2-year period at a single tertiary intensive care nursery. Patients were excluded if their estimated gestational age was greater than 30 weeks or if they did not have a follow-up examination at our institution at 42 weeks' postconception or later, the age by which approximately 95% of eyes reach threshold disease.⁷ The following data were collected: estimated gestational age at birth, birth weight, weekly

Results

Table 1 shows the baseline characteristics of our patients.Of those infants with IVH and mild or no ROP, 11 had grade 1 IVH, 2 had grade 2 IVH, 4 had grade 3 IVH, and 1 had grade 4 IVH. Of those infants with IVH and severe ROP, 8 had grade 1 IVH, 3 had grade 2 IVH, 6 had grade 3 IVH, and 6 had grade 4 IVH. Sixty-six infants were excluded from the study because they did not have a follow-up examination at our institution at 42 weeks' post-conception or later; they had a mean gestational age of

Discussion

This study suggests that poor weight gain in the first 6 weeks of life is an important risk factor for the development of severe (stage 3 or greater) ROP. These results are not explained by the difference in mean birth weight between the patients with severe ROP and those with mild or no ROP. The absolute rate of weight gain in low birth weight infants is proportional to birth weight;¹² consequently, the expected percentage of birth weight gained over the first 6 weeks should be equal for

Acknowledgements

The authors thank Hsiao-Chuan Tien, PhD, for statistical assistance.

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Neonatal sepsis as a cause of retinopathy of prematurity: An etiological explanation
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Retinopathy of prematurity (ROP) is a complex neonatal disorder with multiple contributing factors. In this paper we have mounted the evidence in support of the proposal that neonatal sepsis meets all requirements for being a cause of ROP (not a condition, mechanism, or even innocent bystander) by means of initiating the early stages of the pathomechanism of ROP occurrence, systemic inflammation. We use the model of etiological explanation, which distinguishes between two overlapping processes in ROP causation. It can be shown that sepsis can initiate the early stages of the pathomechanism via systemic inflammation (causation process) and that systemic inflammation can contribute to growth factor aberrations and the retinal characteristics of ROP (disease process). The combined contribution of these factors with immaturity at birth (as intrinsic risk modifier) and prenatal inflammation (as extrinsic facilitator) seems to provide a cogent functional framework of ROP occurrence. Finally, we apply the Bradford Hill heuristics to the available evidence. Taken together, the above suggests that neonatal sepsis is a causal inducer of ROP.
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Nutritional deprivation occurring in most preterm infants postnatally can induce hyperglycemia, a significant and independent risk factor for suppressing physiological retinal vascularization (Phase I retinopathy of prematurity (ROP)), leading to compensatory but pathological neovascularization. Amino acid supplementation reduces retinal neovascularization in mice. Little is known about amino acid contribution to Phase I ROP. In mice modeling hyperglycemia-associated Phase I ROP, we found significant changes in retinal amino acids (including most decreased L-leucine, L-isoleucine, and L-valine). Parenteral L-isoleucine suppressed physiological retinal vascularization. In premature infants, severe ROP was associated with a higher mean intake of parenteral versus enteral amino acids in the first two weeks of life after adjustment for treatment group, gestational age at birth, birth weight, and sex. The number of days with parenteral amino acids support independently predicted severe ROP. Further understanding and modulating amino acids may help improve nutritional intervention and prevent Phase I ROP.
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Infants meeting retinopathy of prematurity (ROP) screening guidelines based on birth weight and gestational age undergo serial examinations by ophthalmologists for detection and treatment. However, less than 10% require treatment, and less than half develop ROP. Slow postnatal weight gain is highly predictive of ROP, and investigators have incorporated weight gain measures to develop more specific criteria for ROP screening. Such clinical prediction model use involves a large development study, validation studies specific to the target populations, and ongoing impact surveillance, with adjustment as necessary. Of the many weight gain inclusive prediction models intended to improve the precision of ROP screening, the Postnatal Growth and ROP (G-ROP) modified screening criteria were developed using the largest dataset and may provide the most robust model for clinical use. A recently completed G-ROP validation study will evaluate the generalizability of these modified criteria prior to clinical use.
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^*: This study was supported in part by a Pediatric Ophthalmology Research Grant from the Knights Templar Eye Foundation, Inc, Chicago, Illinois.

^**: Reprint requests: David K. Wallace, MD, 617 Burnett-Womack, CB #7040, UNC Department of Ophthalmology, Chapel Hill, NC 27599-7040 (e-mail: [email protected]).

^*: J AAPOS 2000;4:343-7

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Major ArticlesPoor postnatal weight gain: A risk factor for severe retinopathy of prematurity*,**,*

Abstract

Section snippets

Subjects and methods

Results

Discussion

Acknowledgements

Am J Ophthalmol

Ophthalmology

Ophthalmology

Am J Ophthalmol

J Pediatr

Retinopathy of prematurity: the relationship with intraventricular hemorrhage and bronchopulmonary dysplasia

J Pediatr Ophthalmol Strabismus

The apparent role of blood transfusions in the development of retinopathy of prematurity

Eur J Pediatr

Major Articles
Poor postnatal weight gain: A risk factor for severe retinopathy of prematurity*,**,*