Relationship between Hyperglycemia and Retinopathy of Prematurity in Very Low Birth Weight Infants

Abstract

Retinopathy of prematurity (ROP) is a multifactorial vasoproliferative retinal disorder that increases in incidence with decreasing gestational age. Recently, an association between hyperglycemia and severe ROP was found in extremely low birth weight infants (ELBWI). The purpose of this study was to evaluate the possible relation between hyperglycemia and ROP at any stage in very low birth weight infants (VLBWI). We analyzed the data of 201 VLBWI. The incidence of ROP and hyperglycemia was detected and the χ² test was applied to investigate the association between the two variables. The Clinical Risk Index for Babies (CRIB) score was attributed as a marker of illness severity. The incidence of ROP and hyperglycemia in VLBWI was 35.3 and 19.4%, respectively. ROP developed more frequently in hyperglycemic infants (p < 0.001). The gestational age, birth weight, and Apgar scores were significantly lower, the CRIB score was higher in ROP patients. In hyperglycemic ROP patients the CRIB score was significantly higher compared to euglycemic ROP patients (mean (SD) 8.1 (4.2) vs. 5.5 (3.3); p < 0.01). A logistic regression model revealed that gestational age (OR 0.59; 95% CI 0.46–0.76; p < 0.001) and hyperglycemia (OR 3.15; 95% CI 1.12–8.84; p < 0.05) are independent risk factors in ROP development. When ELBWI were analyzed separately, gestational age (OR 0.38; 95% CI 0.20–0.72; p < 0.01) and CRIB score (OR 1.58; 95% CI 1.02–2.45; p < 0.05) were found as significant contributors. Further studies are needed to elucidate the pathophysiological role of hyperglycemia in the development of vasoproliferative retinal disorder.

Contribution of early glycemic status in the development of severe retinopathy of prematurity in a cohort of ELBW infants

“…20 Adverse outcomes such as increased severity of ROP have been linked with high glucose levels in ELBW infants. 1,9,10 However, the infants in these studies also had a high severity of illness, making the results difficult to interpret. In this study, using our novel approach to analyze glucose data (TWGL) as a proxy for continuous glucose monitoring, we determined that in ELBW infants glucose levels currently considered within the normal range are linked to the development of severe ROP after correcting for the most significant demographic, perinatal and clinical factors.…”

“…Others have suggested a similar association between high glucose levels and ROP development in VLBW infants; however, because term newborn definitions of hyperglycemia were assumed and data were analyzed as binary categorical variables, the validity of the conclusions is limited. 1,9 Currently ROP is recognized to be multifactorial and not exclusively linked to oxygen exposure. 22 Our current cohort of ELBW infants born between 2004 and 2007 were managed with more homogenous goal saturation parameters, likely explaining the similar maximum and average PaO 2 observed in infants with and without severe ROP.…”

“…8 Recently, high glucose levels have been associated with an increased ROP incidence in ELBW infants. 1,9,10 However, there is no evidence demonstrating a direct cause-effect relationship. The lack of an accepted severity of illness score for newborns after the first 24 h of life 11 complicates interpretation of the data, as glucose instability can be an expression of severity of illness, 12,13 which may be the risk factor for ROP.…”

Development of blood glucose control for extremely premature infants

“…Hyperglycaemia has been linked to worsened outcomes. Associated morbidities include osmotic diuresis, electrolyte imbalance, intraventricular haemorrhage, sepsis, and increased ventilator dependence, retinopathy of prematurity, hospital length of stay and mortality [2][3][4][5][7][8][9]. High rates of proteolysis are also common in low birth weight infants, reducing muscle mass and inhibiting growth [10].…”

Multivariate analysis of hyperglycemia in extremely low birth weight infants

“…6 In a case-control study involving 47 very low birth weight (VLBW) infants Garg et al 8 showed an association between increasing mean blood glucose levels and severe retinopathy of prematurity (ROP), using logistic regression analysis and multiple regression analysis. Ertl et al 9 found a significant relationship between hyperglycemia and ROP in 201 VLBW infants using logistic regression analysis; however, this relationship did not reach statistical significance in the subset of 63 ELBW infants.…”