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Risk factors for retinopathy of prematurity: insights from outlier infants

  • Pediatrics
  • Published:
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Abstract

Purpose

To investigate the characteristics of outlier infants for insights into ROP risk.

Methods

Chart data were collected from 1,354 infants screened for ROP at Weill Cornell Medical Center and Columbia University Medical Center. ROP exam results and clinical risk factors were recorded. The cohort was stratified by weight, highest ROP stage, and need for ROP treatment. Descriptive and correlational statistics were performed.

Results

For the overall cohort, regression analysis found that birth weight (OR: 0.741 per 100 g; 95 % CI: 0.606, 0.905), gestational age at birth (OR: 0.563 per week; 95 % CI: 0.454, 0.697), multiple gestation (OR 2.02, 95 % CI: 1.15, 3.56), bronchopulmonary dysplasia (OR: 4.68, 95 % CI: 1.93, 11.35), and necrotizing enterocolitis (OR 2.80, 95 % CI: 1.40, 5.16) were independent risk factors for treatment-requiring ROP. Black race was found to be a protective factor for treatment-requiring ROP (OR 0.244, 95 % CI: 0.095, 0.626). Among 15 infants with BW <500 g, there were no significant differences in any clinical risk factors between the 12 (80 %) with ROP vs the three (20 %) without ROP. Similarly, among infants with BW >1500 g, the 17 (9 %) with ROP only differed from the 166 (91 %) without ROP with respect to a higher incidence of necrotizing enterocolitis among those with ROP (11.8 % vs 0 %).

Conclusions

Although known clinical risk factors were predictive of ROP stage and need for laser treatment in this cohort, they were not significantly associated with ROP at extremes of birth weight. This suggests that other clinical, maternal, or genetic factors may protect from or predispose to ROP.

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References

  1. Gilbert C (2008) Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. Early Hum Dev 84(2):77–82

    Article  PubMed  Google Scholar 

  2. Palmer EA (1990) Results of U.S. randomized clinical trial of cryotherapy for ROP (CRYO-ROP). Doc Ophthalmol Adv Ophthalmol 74(3):245–251

    Article  CAS  Google Scholar 

  3. Reynolds JD, Dobson V, Quinn GE et al (2002) Evidence-based screening criteria for retinopathy of prematurity: natural history data from the CRYO-ROP and LIGHT-ROP studies. Arch Ophthalmol 120(11):1470–1476

    Article  PubMed  Google Scholar 

  4. Early Treatment For Retinopathy Of Prematurity Cooperative Group (2003) Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol 121(12):1684–1694

    Article  PubMed  CAS  Google Scholar 

  5. Supplemental Therapeutic Oxygen for Prethreshold Retinopathy Of Prematurity (STOP-ROP) (2000) A randomized, controlled trial. I: primary outcomes. Pediatrics 105(2):295–310

    Article  Google Scholar 

  6. Fierson WM (2013) Screening examination of premature infants for retinopathy of prematurity. Pediatrics 131(1):189–195

    Article  PubMed  Google Scholar 

  7. Palmer EA, Flynn JT, Hardy RJ et al (1991) Incidence and early course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology 98(11):1628–1640

    Article  PubMed  CAS  Google Scholar 

  8. Kaempf JW, Kaempf AJ, Wu Y, Stawarz M, Niemeyer J, Grunkemeier G (2011) Hyperglycemia, insulin and slower growth velocity may increase the risk of retinopathy of prematurity. J Perinatol 31(4):251–257

    Article  PubMed  CAS  Google Scholar 

  9. Chiang MF, Arons RR, Flynn JT, Starren JB (2004) Incidence of retinopathy of prematurity from 1996 to 2000: analysis of a comprehensive New York state patient database. Ophthalmology 111(7):1317–1325

    Article  PubMed  Google Scholar 

  10. Isaza G, Arora S, Bal M, Chaudhary V (2013) Incidence of retinopathy of prematurity and risk factors among premature infants at a neonatal intensive care unit in Canada. J Pediatr Ophthalmol Strabismus 50(1):27-32

    Article  PubMed  Google Scholar 

  11. Mathew MRK, Fern AI, Hill R (2002) Retinopathy of prematurity: are we screening too many babies? Eye (Lond) 16(5):538–542

    Article  CAS  Google Scholar 

  12. Lad EM, Hernandez-Boussard T, Morton JM, Moshfeghi DM (2009) Incidence of retinopathy of prematurity in the United States: 1997 through 2005. Am J Ophthalmol 148(3):451–458

    Article  PubMed  Google Scholar 

  13. Moral-Pumarega MT, Caserío-Carbonero S, De-La-Cruz-Bértolo J, Tejada-Palacios P, Lora-Pablos D, Pallás-Alonso CR (2012) Pain and stress assessment after retinopathy of prematurity screening examination: indirect ophthalmoscopy versus digital retinal imaging. BMC Pediatr 12:132

    Article  PubMed  PubMed Central  Google Scholar 

  14. Belda S, Pallás CR, De la Cruz J, Tejada P (2004) Screening for retinopathy of prematurity: is it painful? Biol Neonate 86(3):195–200

    Article  PubMed  Google Scholar 

  15. Mitchell AJ, Green A, Jeffs DA, Roberson PK (2011) Physiologic effects of retinopathy of prematurity screening examinations. Adv Neonatal Care Off J Natl Assoc Neonatal Nurses 11(4):291–297

    Article  Google Scholar 

  16. Rush R, Rush S, Nicolau J, Chapman K, Naqvi M (2004) Systemic manifestations in response to mydriasis and physical examination during screening for retinopathy of prematurity. Retina 24(2):242–245

    Article  PubMed  Google Scholar 

  17. Wright K, Anderson ME, Walker E, Lorch V (1998) Should fewer premature infants be screened for retinopathy of prematurity in the managed care era? Pediatrics 102(1 Pt 1):31–34

    Article  PubMed  CAS  Google Scholar 

  18. Andruscavage L, Weissgold DJ (2002) Screening for retinopathy of prematurity. Br J Ophthalmol 86(10):1127–1130

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  19. Hutchinson AK, O’Neil JW, Morgan EN, Cervenak MA, Saunders RA (2003) Retinopathy of prematurity in infants with birth weights greater than 1250 grams. J AAPOS 7(3):190–194

    Article  PubMed  Google Scholar 

  20. Seiberth V, Linderkamp O (2000) Risk factors in retinopathy of prematurity. a multivariate statistical analysis. Ophthalmologica 214(2):131–135

    Article  PubMed  CAS  Google Scholar 

  21. Schaffer DB, Palmer EA, Plotsky DF et al (1993) Prognostic factors in the natural course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology 100(2):230–237

    Article  PubMed  CAS  Google Scholar 

  22. Binenbaum G, Ying G-S, Quinn GE et al (2012) The CHOP postnatal weight gain, birthweight and gestational age retinopathy risk model. Arch Ophthalmol 130(12):1560–1565

    Article  PubMed  Google Scholar 

  23. Hardy RJ, Palmer EA, Dobson V et al (2003) Risk analysis of prethreshold retinopathy of prematurity. Arch Ophthalmol 121(12):1697–1701

    Article  PubMed  Google Scholar 

  24. Löfqvist C, Hansen-Pupp I, Andersson E et al (2009) Validation of a new retinopathy of prematurity screening method monitoring longitudinal postnatal weight and insulinlike growth factor I. Arch Ophthalmol 127(5):622–627

    Article  PubMed  Google Scholar 

  25. Anon (2001) Screening examination of premature infants for retinopathy of prematurity. Pediatrics 108(3):809–811

    Article  Google Scholar 

  26. Anon (2006) Screening examination of premature infants for retinopathy of prematurity. Pediatrics 117(2):572–576

    Article  Google Scholar 

  27. Good WV, Early Treatment for Retinopathy of Prematurity Cooperative Group (2004) Final results of the Early Treatment for Retinopathy of Prematurity (ETROP) randomized trial. Trans Am Ophthalmol Soc 102:233–248, discussion 248–250

    Google Scholar 

  28. Lang DM, Blackledge J, Arnold RW (2005) Is Pacific race a retinopathy of prematurity risk factor? Arch Pediatr Adolesc Med 159(8):771–773

    Article  PubMed  Google Scholar 

  29. Yang MB, Donovan EF, Wagge JR (2006) Race, gender, and clinical risk index for babies (CRIB) score as predictors of severe retinopathy of prematurity. J AAPOS 10(3):253–261

    Article  PubMed  Google Scholar 

  30. Haroon Parupia MF, Dhanireddy R (2001) Association of postnatal dexamethasone use and fungal sepsis in the development of severe retinopathy of prematurity and progression to laser therapy in extremely low-birth-weight infants. J Perinatol 21(4):242–247

    Article  PubMed  CAS  Google Scholar 

  31. Aralikatti AKV, Mitra A, Denniston AKO, Haque MS, Ewer AK, Butler L (2010) Is ethnicity a risk factor for severe retinopathy of prematurity? Arch Dis Child Fetal Neonatal Ed 95(3):174–176

    Article  Google Scholar 

  32. Saunders RA, Donahue ML, Christmann LM et al (1997) Racial variation in retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Arch Ophthalmol 115(5):604–608

    Article  PubMed  CAS  Google Scholar 

  33. Shastry BS (2010) Genetic susceptibility to advanced retinopathy of prematurity (ROP). J Biomed Sci 17:69

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hiraoka M, Takahashi H, Orimo H, Hiraoka M, Ogata T, Azuma N (2010) Genetic screening of Wnt signaling factors in advanced retinopathy of prematurity. Mol Vis 16:2572–2577

    PubMed  CAS  PubMed Central  Google Scholar 

  35. Ells A, Guernsey DL, Wallace K et al (2010) Severe retinopathy of prematurity associated with FZD4 mutations. Ophthalmic Genet 31(1):37–43

    Article  PubMed  CAS  Google Scholar 

  36. Holmström G, van Wijngaarden P, Coster DJ, Williams KA (2007) Genetic susceptibility to retinopathy of prematurity: the evidence from clinical and experimental animal studies. Br J Ophthalmol 91(12):1704–1708

    Article  PubMed  PubMed Central  Google Scholar 

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Funding Support

Supported by grant EY19474 from the National Institutes of Health (Bethesda, MD, USA) (MFC), NIH/NEI EY010572 (DC), and by unrestricted departmental funding from Research to Prevent Blindness (New York, NY, USA) (ADP, RVPC, SO, MFC). Financial support from Fight For Sight (New York, NY, USA) (ADP) is gratefully acknowledged.

Financial Disclosures

MFC is an unpaid member of the Scientific Advisory Board for Clarity Medical Systems (Pleasanton, CA, USA).

Contributions of Authors

Design and conduct of the study (AP, RVPC, MFC); collection and management of data (AP, SO); analysis and interpretation of the data (AP, RVPC, DC, MFC); preparation and review of the manuscript (AP, RVPC, SO, DC, MFC).

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Weill Cornell Medical College, New York, NY, USA

    Alexander D. Port & R. V. Paul Chan

  2. Department of Ophthalmology, Casey Eye Institute, Oregon Health and Science University, Portland, OR, USA

    Susan Ostmo, Dongseok Choi & Michael F. Chiang

  3. Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, USA

    Dongseok Choi

  4. Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, 3375 SW Terwilliger Boulevard, Portland, OR, 97239, USA

    Michael F. Chiang

Authors
  1. Alexander D. Port
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  2. R. V. Paul Chan
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  3. Susan Ostmo
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  5. Michael F. Chiang
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Corresponding author

Correspondence to Michael F. Chiang.

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Port, A.D., Chan, R.V.P., Ostmo, S. et al. Risk factors for retinopathy of prematurity: insights from outlier infants. Graefes Arch Clin Exp Ophthalmol 252, 1669–1677 (2014). https://doi.org/10.1007/s00417-014-2716-1

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  • DOI: https://doi.org/10.1007/s00417-014-2716-1

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