Factors affecting ROP development in the 8 weeks following birth

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A recent study that analyzed independent risk factors for development of retinopathy of prematurity (ROP) in preterm infants found that low birth weight, blood transfusion, necrotizing enterocolitis, bronchopulmonary dysplasia, and antenatal steroid and surfactant therapies significantly affected the development of ROP.¹

According to this analysis, postnatal weight gain may not accurately predict ROP development after adjusting for confounding factors, reported Mustafa Yildirim, MD, and Asuman Coban, MD, the study’s first authors. Both are from the Department of Pediatrics, Division of Neonatology, Istanbul University Faculty of Medicine, Turkey. Ozgul Bulut, MD; Nur Kir Mercül, MD; and Zeynep Ince, MD,joined Yildirim and Coban in the study.

Weight gain in infants has been evaluated in several studies, but it remains unresolved whether weight affects development of ROP, the authors pointed out. However, information about this subject needs to be clearer regarding poor postnatal weight gain and its association with ROP, even though poor weight gain among these infants has been reported to be a strong indicator of ROP development.^2-5 Yildirim and Coban conducted this study to clarify the relationship between postnatal weight gain and ROP development during the first 8 weeks of life and identify other potential risk factors for development of ROP in preterm infants.

Population-based retrospective cohort study

The study included 675 preterm infants hospitalized in a neonatal intensive care unit. All had gestational ages of 32 weeks or shorter. The authors obtained the infants’ demographic characteristics, clinical findings, and weekly weight gain (g/kg/d) during the first 8 weeks from their medical records.

The authors reported that incidence of ROP in the study infants was 41% (n = 278), and among those infants, 13.3% (n = 37) required treatment. Among the infants in whom ROP developed, the mean birth weight and gestational age were significantly lower than among the infants in whom ROP did not develop (973 ± 288 g and 1301 ± 349 g; P = .001 and 28.48 ± 1.95 weeks and 30.08 ± 1.60 weeks; P = .001, respectively).

With the decrease in the gestational week and birth weight, ROP development and the risk of ROP that required treatment increased. In the infants who developed ROP, the mean weight gain in the postnatal third week was significantly lower compared with those in the group who did not develop ROP (13.9 ± 8.2 g and 15.4 ± 6.8 g; P = .034).

Multiple logistic regression analysis showed that in addition to low birth weight(< 750 g) (OR, 8.67; 95% CI, 3.99-18.82; P = .001), blood transfusion (OR, 2.39; 95% CI, 1.34-4.24; P = .003), necrotizing enterocolitis (OR, 4.79; 95% CI, 1.05-26.85, P = .045), bronchopulmonary dysplasia (OR, 2.03; 95% CI, 1.22-3.36; P = .006), antenatal steroid therapy (OR, 1.60; 95% CI, 1.05-2.43; P = .028) and surfactant administration (OR, 2.06; 95% CI, 1.32-3.2; P = .001) were independent risk factors for ROP development. These results led the authors to report that postnatal weight gain may not accurately predict development of ROP as reported in previous investigations.

According to the investigators, this study’s main strength is that it was the most comprehensive study to evaluate the risk factors in the development of ROP among the studies conducted to this date. However, because of inherent limitations, they advised that prospective multicenter cohort studies be conducted to study relationships between postnatal weight gain and ROP.

“Based on our study, postnatal weight gain, as predicted in previous studies, may not be an accurate predictor of ROP development after adjusting for confounding factors,” the researchers concluded. “However, the analysis of independent risk factors that influenced the development of ROP revealed a statistically significant effect in cases of low birth weight, blood transfusion, necrotizing enterocolitis, bronchopulmonary dysplasia, and antenatal steroid and surfactant therapies.” They hope that this new information may be useful to ophthalmologists and neonatologists and that it will alert them to this patient group during screening for ROP.

Mustafa Yildirim, MD

E: +90 2124142000

Yildirim is from the Department of Pediatrics, Division of Neonatology, Istanbul University Faculty of Medicine, Turkey. Yildirim has no disclosures related to the content of this article.

Asuman Coban, MD

E: +90 2124142000

Coban is from the Department of Pediatrics, Division of Neonatology, Istanbul University Faculty of Medicine, Turkey. Coban has no disclosures related to the content of this article.

References:

1. Yildirim M, Coban A, Bulut O, Mercül NK, Ince Z. Postnatal weight gain and retinopathy of prematurity in preterm infants: a population-based retrospective cohort study. J Matern Fetal Neonatal Med.2024;37(1):2337720. doi:10.1080/14767058.2024.2337720

2. Hellström A, Hård AL, Engström E, et al. Early weight gain predicts retinopathy in preterm infants: new, simple, efficient approach to screening. Pediatrics. 2009;123(4):e638-e645. doi:10.1542/peds.2008-2697

3. Wallace DK, Kylstra JA, Phillips SJ, Hall JG. Poor postnatal weight gain: a risk factor for severe retinopathy of prematurity. J AAPOS. 2000;4(6):343-347. doi:10.1067/mpa.2000.11034

4. Cabañas Poy MJ, Montoro Ronsano JB, Castillo Salinas F, Martín Begué N, Clemente Bautista S, Gorgas Torner MQ. Association between postnatal weight gain and need for treatment in retinopathy of prematurity. J Matern Fetal Neonatal Med. 2022;35(25):8027-8031. doi:10.1080/14767058.2021.1940937

5. Bas AY, Demirel N, Koc E, Ulubas Isik D, Hirfanoglu İM, Tunc T; TR-ROP Study Group. Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units. Br J Ophthalmol. 2018;102(12):1711-1716. doi:10.1136/bjophthalmol-2017-311789