Systemic fungal infection is associated with the development of retinopathy of prematurity in very low birth weight infants: a meta-review

Abstract

Objective: To study the association between systemic fungal infection (SFI) and the development of retinopathy of prematurity (ROP) and severe ROP in very low birth weight (VLBW) infants by systematic review and meta-analysis.Study Design: A meta-review was performed using a fixed effects model. The exposure and outcomes studied were SFI and all ROP/severe ROP, respectively in VLBW infants. Results and effect sizes analyzed with Review Manager 4.2 software are expressed as relative risk (RR), odds ratio (OR), risk difference (RD) and number needed to harm (NNH) with 95% confidence intervals.Result: Data for severe ROP were available from eight studies and on all ROP from seven of those eight studies. Estimated gestational age ranged from 24.7±1.6 to 28.6±4 weeks and birth weight from 673 (median) (range 426 to 995) to 1108 ± 266 g (mean ± s.d.). A total of 261 of 303 babies with SFI had all ROP vs 1081 of 1648 babies without SFI (OR 3.4*, 2.34-4.95) and 118 of 330 babies with SFI had severe ROP vs 235 of 1951 babies without SFI (OR 4.06*,). The NNH was 5.56* (4.54-7.14) for all ROP and 4.54* (3.70 to 5.88) for severe ROP (*P<0.00001).Conclusion: SFIs are associated with the development of all degrees of ROP and severe ROP in VLBW infants.

Infection, Oxygen, and Immaturity: Interacting Risk Factors for Retinopathy of Prematurity

“…Our finding that neonatal sepsis is a significant risk factor for ROP is also in keeping with previous studies [9,10,36,37] . In our univariable analyses, both bacterial sepsis and fungal sepsis were associated with increased risk of ROP, confirming one meta-analysis [38] and multiple observational studies [10,11,36] . As expected based on received knowledge, oxygen exposure was a strong predictor of ROP.…”

Assessment of the Contribution of Cytokine Plasma Levels to Detect Retinopathy of Prematurity in Very Low Birth Weight Infants

“…[2][3][4][5] Recently, Dammann et al 6,7 have found some evidence in support of the contention that multiple "hits" of exposure to perinatal inflammation and infection might contribute to a gradual increase in the risk for ROP. Chen et al 8 suggested that neonatal sepsis, oxygen exposure, and low gestational age (GA) are not only independently associated with ROP occurrence, they interact and have a multiplicative effect on development of ROP.…”

Serum Fructosamine and Retinopathy of Prematurity

“…Similarly, restriction of the supplied oxygen concentration to 88-93% in the present study did not decrease the number of infants diagnosed with ROP [26]. The development of ROP has been attributed to several factors including oxygen treatment [21], sepsis [27], candidiasis [28], IVH [29], PDA, RDS, TPN [30], PBP transfusions [31], and steroid therapy [32], but despite this knowledge, no improvement to reduce the incidence of ROP has been developed recently.…”