Hidden risks of respiratory support in neonates: retinopathy of prematurity
Keywords:retinopathy of prematurity, respiratory support, non-invasive ventilation, intensive care, premature neonate, risk factors
Background. Retinopathy of prematurity (RP) is the main reason for visual disability in premature survivors. RP increases chances for re-hospitalization and re-admission for special help by 1.5–4 times. It can lead to blindness in childhood. Risk factors for RP are mechanical ventilation and oxygen as well as weight gain problems in the postnatal period. The purpose was to assess the influence of different elements of intensive care on the development of severe RP, particularly, respiratory support strategies. Materials and methods. Simple retro-prospective blind non-randomized trial in two separate medical centers of Dnipro enrolled 122 premature neonates with the gestational age of 28–32 weeks from 2016 till 2020. The endpoint for assessment was the development of moderate and severe RP. We performed a univariate logistic regression analysis to analyze the odds ratio and 95% confidence interval (95% CI) for main risk factors. The confidence p level was 0.05. Results. Eighteen percent of premature neonates presented with moderate or severe RP on the 14th day of intensive care according to routine ophthalmologic examination. The moderate and severe RP was associated with an increase in length of noninvasive respiratory care by 4 times (p = 0.01), prolonged conventional ventilation by two-fold (p = 0.33), CPAP length by 4.5 times (p = 0.05), longer usage of additional oxygen (FiO2 > 30 %) by 4 times (p = 0.01). AUC for all these predictors ranged from 0.63 to 0.68. We found the following main predictors of retinopathy. According to statistics, every single day of respiratory support increases the chance of moderate or severe RP by 7–9 % depending on ventilation method, and caffeine citrate usage increases this chance by 6 times. Every 100 g of weight decrease is associated with a 16% increase in RP development risk (p = 0.03). Conclusions. Any respiratory support increases the risk of moderate and severe RP. Thus, the usage of these intensive care modalities can’t be preventive. Attentive modes of weight control should help in the prophylaxis of RP development as well as usual ophthalmologic examinations.
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