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Association of small for gestational age with retinopathy of prematurity: a systematic review and meta-analysis
  1. Abdul Razak1,2,
  2. Maher Faden1
  1. 1 Pediatrics, Princess Nourah bint Abdulrahman University, King Abdullah bin Abdulaziz University Hospital, Riyadh, Al Riyadh, Saudi Arabia
  2. 2 Pediatrics, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Abdul Razak, Associate Clinical Professor, Princess Nourah bint Abdulrahman University, King Abdullah bin Abdulaziz University Hospital, Riyadh, Al Riyadh, Saudi Arabia; razakmdpaed{at}gmail.com

Abstract

Context The association between small for gestational age (SGA) and retinopathy of prematurity (ROP) is unclear.

Objective A systematic review and meta-analysis was conducted to evaluate the association between ROP and SGA in preterm infants <37 weeks’ gestational age (GA) admitted to neonatal intensive care unit.

Methods Medline, PubMed, Web of Science and Cochrane Central databases were searched from inception through 15 January 2019. Studies reporting outcomes based on SGA as the primary exposure variable were included. Data were extracted independently by two coauthors. Modified Newcastle-Ottawa scale was used for risk of bias assessment.

Results Database search yielded 536 records (Medline=152, PubMed=171, Web of Science=144 and Cochrane Central=69). Twenty-one studies evaluating 190 946 infants were included. SGA was associated with significantly higher odds of any stage of ROP on unadjusted analysis (unadjusted OR (uOR) 1.55; 95% CI 1.22 to 1.98; 10 studies) but not on adjusted analysis (adjusted OR (aOR) 2.16; 95% CI 0.66 to 7.11; 3 studies). SGA was associated with significantly higher odds of severe ROP (aOR 1.92; 95% CI 1.57 to 2.34; nine studies). SGA was also significantly associated with higher odds of treated ROP (aOR 1.39; 95% CI 1.18 to 1.65; three studies). In subgroup analysis of infants <29 weeks’ GA, SGA was significantly associated with increased odds of ROP (uOR 1.64; 95% CI 1.19 to 2.26; two studies), severe ROP (aOR 1.61; 95% CI 1.23 to 2.10; four studies) and treated ROP (aOR 1.37; 95% CI 1.16 to 1.62; two studies).

Conclusion SGA was associated with increased odds of any stage of ROP, severe ROP and treated ROP in preterm infants. Neonatologists should incorporate SGA into the risk assessment during ROP evaluation and while providing counselling to the families of preterm SGA infants. ROP screening guidelines should look into the frequency of follow-up examination in SGA infants in aim to offer early detection and treatment.

  • neonatology
  • retinopathy
  • small for gestational age
  • preterm
  • growth
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Footnotes

  • Contributors AR conceptualised and designed the study, performed the initial screening of the articles, abstracted the data, performed initial analyses including risk of bias assessment, drafted the manuscript and approved the final version. MF double checked the initial screening of articles and double checked all the data extraction from included studies including risk of bias assessment, revised the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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