Risk factors for retinopathy of prematurity identified

By Joanna Lyford, Senior medwireNews Reporter

Birthweight and gestational age are risk factors for retinopathy of prematurity (ROP) and should be considered when screening infants for the condition, a study by Turkish researchers shows.

"To prevent the irreversible visual loss, the population at risk should be better identified, risk factors should be recognized and appropriate screening criteria adopted," say Bilge Araz-Ersan (Kanuni Sultan Suleyman Education and Research Hospital, Istanbul) and co-authors writing in the British Journal of Ophthalmology.

The researchers reviewed data on 2950 preterm infants who were screened for ROP at Istanbul Faculty of Medicine between 1996 and 2010. The mean gestational age was 31.2 weeks and mean birthweight was 1543.4 g.

In all, 1203 infants were diagnosed with ROP and 467 with severe ROP; these children tended to have a lower gestational age and lower birthweight than the overall cohort.

Among the subset of 788 infants who were inpatients at the center, logistic regression analysis identified six significant risk factors for the development of ROP. These were a birthweight of less than 1500 g (odds ratio [OR]=6.0); a gestational age of less than 32 weeks (OR=2.8); intraventricular hemorrhage (OR=2.4); respiratory distress syndrome (OR=2.2); sepsis (OR=2.2); and apnea (OR=1.5).

Meanwhile, phototherapy was significantly protective against ROP development, with an OR of 0.6.

A further four factors were significantly associated with progression to severe ROP. These were sepsis (OR=6.9); male gender (OR=2.2); multiple gestations (3.0); and birthweight of less than 1500 g (OR=6.4), whereas maternal pre-eclampsia was associated with a reduced risk (OR=0.2).

A separate analysis found that the subset of referred infants with ROP had a significantly higher birthweight and were treated at a significantly younger age than the inpatient infants with ROP.

Taken together, the findings indicate that current recommendations for the screening of premature infants at risk for visual disability failed to detect all cases of severe ROP, Araz-Ersan et al write.

While both birthweight and gestational age are risk factors for ROP, low birthweight has the strongest impact, at least in this Turkish population, they add.

The researchers conclude: "The high birthweight and gestational age of infants with ROP and severe ROP show that the level of neonatal care should be improved. Until those criteria are established, caution should be taken, and a wider screening criteria than highly developed countries should be used."

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