Key Words: retinopathy of prematurity, case-control studies, neonatal sepsis
Abstract
Background
Retinopathy of prematurity is the leading worldwide cause of visual impairment. There is little available data on its epidemiology and related factors and consequences in developing countries such as Peru. Due to this lack of information, we decided to do this study.
Objectives
To evaluate factors related to the development of retinopathy of prematurity in very low birth weight newborn patients.
Methods
We did a case-control (paired 1:1) study of patients admitted to the Neonatal Intensive Care Unit of the Hospital Cayetano Heredia between 2008 and 2018 who had a complete record in the Neocosur network database (N = 293). The case was defined as a preterm newborn patient with a birth weight lower than 1500 grams who developed any type or stage of retinopathy of prematurity; control was defined as a patient with similar characteristics without retinopathy. Univariate and bivariate analysis (using logistic regression model) was performed to obtain the odds ratio with a 95% confidence interval.
Results
Data were obtained from 57 cases and 57 controls admitted to the Neonatal Intensive Care Unit at Hospital Cayetano Heredia. Late-onset sepsis was the main factor associated with retinopathy of prematurity (odds ratio 4.39; 95% confidence interval 1.23 to 15.76, p = 0.02). Additionally, we performed a bivariate and multivariate analysis that showed that exposure to supplementary oxygen at 36 weeks of postmenstrual age and retinopathy of prematurity were not significantly associated (8.47; 0.51 to 141.17, p = 0.14).
Conclusions
Patients with late-onset sepsis have a 4.39 times higher odds of developing retinopathy of prematurity. Prospective studies are needed with larger sample sizes.
No English version is available for this article.
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Introducción
La retinopatía de la prematuridad es una causa importante de discapacidad visual. Existe poca información sobre la epidemiología, factores asociados con su desarrollo y consecuencias para países de medianos ingresos como Perú.
Objetivo
Evaluar factores asociados al desarrollo de retinopatía de la prematuridad en recién nacidos pretérmino con peso menor de 1500 gramos.
Métodos
Estudio de casos y controles (pareados 1:1) de pacientes admitidos en la unidad de cuidados intensivos neonatales del Hospital Cayetano Heredia durante el periodo de 2008 a 2018, con registro completo en la base de datos de la red Neocosur (N = 293). Caso: paciente recién nacido pretérmino con peso al nacer menor de 1500 gramos, que haya desarrollado cualquier tipo o grado de retinopatía; control: paciente con las mismas características, sin retinopatía. Se realizó análisis bivariado y multivariado (empleando modelo de regresión logística) para obtener Odds ratio, utilizando un intervalo de confianza del 95%.
Resultados
La información se obtuvo de 57 casos y 57 controles. El antecedente de sepsis tardía se asocia de manera significativa con el desarrollo de retinopatía de la prematuridad (Odds ratio 4,39; intervalo de confianza 95%; 1,23 a 15,76; p = 0,02). Al realizar el análisis bivariado y el análisis multivariado no se encontró asociación estadísticamente significativa entre la exposición a oxígeno a las 36 semanas de edad postmenstrual y el desarrollo de retinopatía de la prematuridad (Odds ratio 8,47; intervalo de confianza 95%; 0,51 a 141,17; p = 0,14).
Conclusiones
En pacientes con antecedente de sepsis tardía, la probabilidad de desarrollar retinopatía de la prematuridad fue 4,39 veces mayor. Se requieren estudios prospectivos que involucren un mayor tamaño muestral.
Authors:
Alvaro Valdivia[1], Daniela Bullard Elias[1], Cecilia Herbozo[1], German Málaga[1]
Affiliation:
[1] Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
E-mail: alvaro.valdivia.t@upch.pe
Author address:
[1] Calle Trípoli 360 Dpto. 201 Miraflores, Lima, Perú
Citation: Valdivia A, Bullard Elias D, Herbozo C, Málaga G. Severe sepsis and retinopathy of prematurity in very low birth weight preterm newborns in a third-level healthcare center in Lima, Peru between 2008 and 2018: A case-control study. Medwave 2021;21(3):e8157 doi: 10.5867/medwave.2021.03.8157
Submission date: 30/5/2020
Acceptance date: 24/2/2021
Publication date: 19/4/2021
Origin: Not commissioned
Type of review: Externally peer-reviewed by three reviewers, double-blind
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- Díaz M, Cruzado-Sánchez D. Factores de riesgo neonatales asociados a retinopatía de la prematuridad. Revista peruana de epidemiología. 2012;16(2):127-30. [On line]. | Link |
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- Kim SJ, Port AD, Swan R, Campbell JP, Chan RVP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv Ophthalmol. 2018 Sep-Oct;63(5):618-637. | CrossRef | PubMed |
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Kang HG, Choi EY, Byeon SH, Kim SS, Koh HJ, Lee SC, et al. Anti-vascular Endothelial Growth Factor Treatment of Retinopathy of Prematurity: Efficacy, Safety, and Anatomical Outcomes. Korean J Ophthalmol. 2018 Dec;32(6):451-458. | CrossRef | PubMed |Fierson WM; AMERICAN ACADEMY OF PEDIATRICS Section on Ophthalmology; AMERICAN ACADEMY OF OPHTHALMOLOGY; AMERICAN ASSOCIATION FOR PEDIATRIC OPHTHALMOLOGY AND STRABISMUS; AMERICAN ASSOCIATION OF CERTIFIED ORTHOPTISTS. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics. 2018 Dec;142(6):e20183061. | CrossRef | PubMed |Carrion JZ, Fortes Filho JB, Tartarella MB, Zin A, Jornada ID Jr. Prevalence of retinopathy of prematurity in Latin America. Clin Ophthalmol. 2011;5:1687-95. | CrossRef | PubMed |Díaz M, Cruzado-Sánchez D. Factores de riesgo neonatales asociados a retinopatía de la prematuridad. Revista peruana de epidemiología. 2012;16(2):127-30. [On line]. | Link |Mendoza Díaz KM. Incidencia y perfil epidemiológico de recién nacidos prematuros con retinopatía de la prematuridad en el Instituto Nacional Materno Perinatal. Lima - Perú. [Tesis de pregrado]. Perú: Universidad Nacional Federico Villarreal; 2018. [On line]. | Link |Leng Y, Huang W, Ren G, Cai C, Tan Q, Liang Y, et al. The treatment and risk factors of retinopathy of prematurity in neonatal intensive care units. BMC Ophthalmol. 2018 Nov 20;18(1):301. | CrossRef | PubMed |Kim SJ, Port AD, Swan R, Campbell JP, Chan RVP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv Ophthalmol. 2018 Sep-Oct;63(5):618-637. | CrossRef | PubMed |Villamor-Martinez E, Cavallaro G, Raffaeli G, Mohammed Rahim OMM, Gulden S, Ghazi AMT, et al. Chorioamnionitis as a risk factor for retinopathy of prematurity: An updated systematic review and meta-analysis. PLoS One. 2018 Oct 17;13(10):e0205838. | CrossRef | PubMed |Tanner SM, Berryhill TF, Ellenburg JL, Jilling T, Cleveland DS, Lorenz RG, et al. Pathogenesis of necrotizing enterocolitis: modeling the innate immune response. Am J Pathol. 2015 Jan;185(1):4-16. | CrossRef | PubMed |Heller CD, O'Shea M, Yao Q, Langer J, Ehrenkranz RA, Phelps DL, et al. Human milk intake and retinopathy of prematurity in extremely low birth weight infants. Pediatrics. 2007 Jul;120(1):1-9. | CrossRef | PubMed |Ginovart G, Gich I, Verd S. Human milk feeding protects very low-birth-weight infants from retinopathy of prematurity: a pre-post cohort analysis. J Matern Fetal Neonatal Med. 2016 Dec;29(23):3790-5. | CrossRef | PubMed |International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005 Jul;123(7):991-9. | CrossRef | PubMed |Al-Essa M, Azad RV, Rashwan N. Threshold stage of retinopathy of prematurity: maternal and neonatal risk factors. Ann Saudi Med. 2000 Mar;20(2):129-31. | CrossRef | PubMed |Reyes ZS, Al-Mulaabed SW, Bataclan F, Montemayor C, Ganesh A, Al-Zuhaibi S, et al. Retinopathy of prematurity: Revisiting incidence and risk factors from Oman compared to other countries. Oman J Ophthalmol. 2017;10(1):26-32. | CrossRef |Thomas K, Shah PS, Canning R, Harrison A, Lee SK, Dow KE. Retinopathy of prematurity: Risk factors and variability in Canadian neonatal intensive care units. J Neonatal Perinatal Med. 2015;8(3):207-14. | CrossRef | PubMed |Ventura Chilón JJ. Incidencia y factores de riesgo de retinopatía de la prematuridad en el servicio de Neonatología del Hospital Regional de Cajamarca en el periodo Enero 2012 - Diciembre 2013. [Tesis de pregrado]. Perú: Universidad Nacional de Cajamarca; 2014. [On line]. | Link |Gayoso M, Genaro S, Sáenz S, Webb D, Rospigliosi M, Rivera F. Preeclampsia como factor asociado al desarrollo de retinopatía en prematuros de muy bajo peso al nacer, nacidos en el Hospital Nacional Cayetano Heredia entre enero 2005 y diciembre 2011. Rev Peru Pediatr. 2013;66(2):73-83. [On line]. | Link |Pastro J, Toso BRGO. Influence of oxygen in the development of retinopathy of prematurity. Rev Bras Enferm. 2019 Jun 27;72(3):592-599. | CrossRef | PubMed |Chang JW. Risk factor analysis for the development and progression of retinopathy of prematurity. PLoS One. 2019 Jul 18;14(7):e0219934. | CrossRef | PubMed |Zhou J, Shukla VV, John D, Chen C. Human Milk Feeding as a Protective Factor for Retinopathy of Prematurity: A Meta-analysis. Pediatrics. 2015 Dec;136(6):e1576-86. | CrossRef | PubMed |Bas AY, Demirel N, Koc E, Ulubas Isik D, Hirfanoglu İM, Tunc T, et al. 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 Dec;102(12):1711-1716. | CrossRef | PubMed |Gebeşçe A, Uslu H, Keleş E, Yildirim A, Gürler B, Yazgan H, et al. Retinopathy of prematurity: incidence, risk factors, and evaluation of screening criteria. Turk J Med Sci. 2016 Feb 17;46(2):315-20. | CrossRef | PubMed |Zhu T, Zhang L, Zhao F, Qu Y, Mu D. Association of maternal hypertensive disorders with retinopathy of prematurity: A systematic review and meta-analysis. PLoS One. 2017 Apr 7;12(4):e0175374. | CrossRef | PubMed |Morley CJ, Davis PG, Doyle LW, Brion LP, Hascoet JM, Carlin JB, et al. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008 Feb 14;358(7):700-8. | CrossRef | PubMed |SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network, Finer NN, Carlo WA, Walsh MC, Rich W, Gantz MG, et al. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010 May 27;362(21):1970-9. | CrossRef | PubMed |Gutiérrez-Gutiérrez CI, Vergara-Wekselman EF, Rojas-Herrera P, Labrín-Palacios C. Retinopatía de la prematuridad en el hospital Regional Docente Las Mercedes. Chiclayo 2007-2009. Rev Cuerpo Méd. HNAAA. 2012;5(1):30-32. [On line]. | Link |Mintz-Hittner HA, Geloneck MM, Chuang AZ. Clinical Management of Recurrent Retinopathy of Prematurity after Intravitreal Bevacizumab Monotherapy. Ophthalmology. 2016 Sep;123(9):1845-55. | CrossRef | PubMed |Roberts JM, August PA, Bakris G, Barton JR, Bernstein IM, Druzin M, et al. Hypertension in pregnancy. 1st ed. Washington DC: ACOG; 2013. Kesavan K, Devaskar SU. Intrauterine Growth Restriction: Postnatal Monitoring and Outcomes. Pediatr Clin North Am. 2019 Apr;66(2):403-423. | CrossRef | PubMed |Sánchez Luna M, Moreno Hernando J, Botet Mussons F, Fernández Lorenzo JR, Herranz Carrillo G, Rite Gracia S, et al. Displasia broncopulmonar: definiciones y clasificación [Bronchopulmonary dysplasia: definitions and classifications]. An Pediatr (Barc). 2013 Oct;79(4):262.e1-6. | CrossRef | PubMed |
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