Threshold Stage of Retinopathy of Prematurity: Maternal and Neonatal Risk Factors

Abstract

Background:The aim of this study was to review the maternal and neonatal risk factors associated with retinopathy of prematurity (ROP) and the threshold stage of the disease. Patients and Methods: In this prospective cohort study, all preterm infants of less than 1501 g birth weight were screened for ROP between January 1996 and December 1997 at the neonatal unit of the Maternity Hospital in Kuwait. The rate of the threshold stage of ROP, as well as risk factors associated with the disease, were identified. Results: A total of 234 babies were screened for ROP, of which 151 (64.5%) developed the disease and 34 (14.5%) had the threshold stage of ROP. Several factors were found to be associated with ROP and threshold ROP. Stepwise regression analysis revealed that low birth weight (P<0.002) and exposure to high oxygen concentration (P<0.0001) were independently associated with ROP. In addition, low birth weight (P<0.006), high oxygen concentration (P<0.003), and culture-proven sepsis (P<0.04) were found to be independent predictors of threshold ROP. Conclusion: Apart from low birth weight and exposure to high oxygen therapy, which are well-documented risk factors of ROP, septicemia was also found to be associated with the threshold stage of ROP.

Type I retinopathy of prematurity in infants with birth weight less than 1251 g: Incidence and risk factors for its development in a nursery in Kuwait

“…Other risk factors found to be significant were the presence of sepsis, NEC, number of ventilated days, number of blood units transfused, need for medical or surgical treatment for PDA, and HMD of grade 3 or more [Tables 1 and 2]. Other studies too have found low BW, low GA, respiratory distress syndrome, number of blood units transfused, and number of ventilated days to be significant risk factors for the development of severe ROP requiring treatment among the screened population 7920–2224–26…”

Results of screening for retinopathy of prematurity in a large nursery in Kuwait: Incidence and risk factors

“…[7121516] In a study conducted in our center in 1996-97, ROP was found among 64.5% of babies with birth weight of less than 2000 g.[17] The higher incidence of ROP could be due to smaller babies in the earlier cohort. [17] A decreasing incidence of ROP has been observed by some authors[4519] and this has been attributed to the introduction of use of Surfactant[5] or to the improving neonatal care and better monitoring of oxygen saturation. [19]…”

“…Low birth weight has been consistently found to be significant for the development of threshold disease in other studies too. [61217] Some studies have found presence of IVH[13] and fungal infection[14] to be significant for the development of threshold disease.…”

“…[1215–17] The objective of this study was to report the incidence of any ROP, incidence of severe ROP needing treatment and the risk factors for them in a large nursery in Kuwait.…”

Increased postnatal concentrations of pro-inflammatory cytokines are associated with reduced IGF-I levels and retinopathy of prematurity

“…Other factors beyond low gestational age (GA) at birth and low postnatal levels of IGF-I that have been identified as risk factors for ROP include low birth weight and poor postnatal growth, sub-optimal oxygen therapy, depletion of the maternal supply of growth and nutritional factors, and red blood cell transfusion [1,4–6]. In addition to risk factors specifically associated with preterm birth, perinatal or neonatal infections followed by a systemic inflammatory response with the activation of pro-inflammatory cytokines have been suggested to increase the risk for severe ROP [7–10], but contradictory data have been reported [11–13]. …”