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Association between neonatal hyperglycemia and retinopathy of prematurity: a meta-analysis

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Abstract

Through a meta-analysis, we aimed to investigate whether neonatal hyperglycemia was associated with an increased risk of retinopathy of prematurity (ROP) by summarizing all available observational evidence. We searched online databases for studies published prior to December 2020; 26745 neonates with 3227 cases of ROP in 11 case–control studies and 997 neonates with 496 cases of hyperglycemia in 5 cohort studies were included. The results showed that the association between hyperglycemia and the occurrence of ROP was statistically significant in case–control studies (OR 3.93, 95% CI 2.36–6.53) and cohort studies (OR 1.70, 95% CI 1.11–2.60). Besides, the borderline significant association between the duration of hyperglycemia and ROP was observed in case–control studies (MD = 1.96, 95% CI 0.90–3.03; adjusted OR = 1.08, 95% CI 1.01–1.15). Furthermore, we found that the mean blood glucose level is higher in the ROP group than the non-ROP group in case–control studies (MD = 14.86, 95% CI 5.06–24.66) and the mean blood glucose level is higher in the hyperglycemia group than in the non-hyperglycemia group (MD = 86.54, 95% CI 11.03–162.05). However, after adjusting other confounders, the association between the mean blood glucose level and ROP varied in cohort studies (OR 1.96, 95% CI 1.23–3.13) and case–control studies (OR 1.02, 95% CI 1.00–1.05).

Conclusion: This meta-analysis demonstrates that preterm infants with hyperglycemia have a tendency to increase the risk of ROP. Further studies will be required to achieve a firm conclusion for hyperglycemia and ROP and promote a better understanding of the prevention of ROP.

Trial registration: CRD42021228733

What is Known:

• Hyperglycemia including the duration and daily mean blood glucose concentration has been associated with the risk of developing ROP in some clinical studies. Current evidence cannot reach a consensus on whether neonatal hyperglycemia is a risk factor for ROP.

What is New:

• This meta-analysis demonstrates that preterm infants with hyperglycemia have a tendency to increase the risk of ROP.

• While the association between the mean blood glucose level and ROP remains inconclusive.

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Abbreviations

ROP:

Retinopathy of prematurity

VEGF:

Vascular endothelial growth factor

IGF-1:

Insulin-like growth factor-1

OR:

Odds ratios

RR:

Relative risks

CI:

Confidence interval

NOS:

Newcastle-Ottawa Scale

MD:

Mean difference

SD:

Standard deviation

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Funding

This work was supported by 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZYJC21025) and National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University (Z2018B22). The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

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  1. Chunyan Lei and Jianan Duan contributed equally to this work.

Authors and Affiliations

  1. Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, 610041, China

    Chunyan Lei, Jianan Duan, Ge Ge & Meixia Zhang

  2. Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, 610041, China

    Chunyan Lei, Jianan Duan, Ge Ge & Meixia Zhang

  3. National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, China

    Meixia Zhang

  4. Department of Ophthalmology and Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan, China

    Meixia Zhang

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  1. Chunyan Lei
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Contributions

C.L. conceptualized and designed the study; conducted literature searches, study selections, and data extractions; and drafted the initial manuscript. J.D. conducted literature searches, study selections, and data extractions and reviewed and revised the manuscript. G.G. reviewed and revised the manuscript. M.Z. conceptualized and designed the study and reviewed and revised the manuscript. All authors have approved the final manuscript and agree to be accountable for all aspects of the work.

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Correspondence to Meixia Zhang.

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Supplemental Table 1

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Lei, C., Duan, J., Ge, G. et al. Association between neonatal hyperglycemia and retinopathy of prematurity: a meta-analysis. Eur J Pediatr 180, 3433–3442 (2021). https://doi.org/10.1007/s00431-021-04140-w

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