Hidden risks of respiratory support in neonates: retinopathy of prematurity

Authors

  • A.V. Bolonska Dnipro State Medical University, Dnipro, Ukraine
  • O.Yu. Sorokina Dnipro State Medical University, Dnipro, Ukraine

DOI:

https://doi.org/10.22141/2224-0586.17.3.2021.234806

Keywords:

retinopathy of prematurity, respiratory support, non-invasive ventilation, intensive care, premature neonate, risk factors

Abstract

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.

References

Dogra M.R., Katoch D., Dogra M. An Update on Retinopathy of Prematurity (ROP). Indian J. Pediatr. 2017 Dec. 84(12). 930-936. doi: 10.1007/s12098-017-2404-3. Epub 2017, Jul 4.

Kim S.J., Port A.D., Swan R., Campbell J.P., Chan R.V.P., Chiang M.F. Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv. Ophthalmol. 2018 Sep-Oct. 63(5). 618-637. doi: 10.1016/j.survophthal.2018.04.002. Epub 2018, Apr 19. PMID: 29679617; PMCID: PMC6089661.

Kuint J., Lerner-Geva L., Chodick G., Boyko V., Shalev V., Reichman B. Israel Neonatal Network. Rehospitalization Through Childhood and Adolescence: Association with Neonatal Morbidities in Infants of Very Low Birth Weight. J. Pediatr. 2017 Sep. 188. 135-141. e2. doi: 10.1016/j.jpeds.2017.05.078. Epub 2017, Jun 26. PMID: 28662947.

Farooqi A., Hägglöf B., Sedin G., Serenius F. Impact at age 11 years of major neonatal morbidities in children born extremely preterm. Pediatrics. 2011 May. 127(5). e1247-57. doi: 10.1542/peds.2010-0806. Epub 2011, Apr 11. PMID: 21482612.

Multicenter Study Group. Prethreshold Retinopathy Of Prematurity (STOP-ROP), a randomized, controlled trial. I: primary outcomes. Pediatrics. 2000 Feb. 105(2). 295-310. doi: 10.1542/peds.105.2.295.

Vanderveen D.K., Mansfield T.A., Eichenwald E.C. Lower oxygen saturation alarm limits decrease the severity of retinopathy of prematurity. J. AAPOS. 2006 Oct. 10(5). 445-448. doi: 10.1016/j.jaapos.2006.04.010. PMID: 17070480.

Schmidt B., Whyte R.K., Asztalos E.V. et al. Canadian Oxygen Trial (COT) Group. Effects of targeting higher vs lower arterial oxygen saturations on death or disability in extremely preterm infants: a randomized clinical trial. JAMA. 2013, May 22. 309(20). 2111-2120. doi: 10.1001/jama.2013.5555. PMID: 23644995.

Hauspurg A.K., Allred E.N., Vanderveen D.K. et al. Blood gases and retinopathy of prematurity: the ELGAN Study. Neonatology. 2011. 99(2). 104-111. doi: 10.1159/000308454. Epub 2010, Jul 30. PMID: 20689332; PMCID: PMC2939988.

Hartnett M.E. Advances in understanding and management of retinopathy of prematurity. Surv Ophthalmol. 2017 May-Jun. 62(3). 257-276. doi: 10.1016/j.survophthal.2016.12.004. Epub 2016, Dec 22. PMID: 28012875; PMCID: PMC5401801.

Bassler D. Inhalation or instillation of steroids for the prevention of bronchopulmonary dysplasia. Neonatology. 2015. 107(4). 358-359. doi: 10.1159/000381132. Epub 2015, Jun 5. PMID: 26044104.

Wu J., Wen Z.H., Liu D.D. et al. Safety evaluation on different ventilation strategies set for neonatal respiratory distress syndrome: a network Meta-analysis. Zhonghua Liu Xing Bing Xue Za Zhi. 2020, Feb 10. 41(2). 249-260. Chinese. doi: 10.3760/cma.j.issn.0254-6450.2020.02.020. PMID: 32164138.

Cao H., Li H., Zhu X. et al. Three non-invasive ventilation strategies for preterm infants with respiratory distress syndrome: a propensity score analysis. Arch. Med. Sci. 2020, Mar 9. 16(6). 1319-1326. doi: 10.5114/aoms.2020.93541. PMID: 33224330; PMCID: PMC7667431.

Coalson J.J. Pathology of bronchopulmonary dysplasia. Semin Perinatol. 2006 Aug. 30(4). 179-184. doi: 10.1053/j.semperi.2006.05.004. PMID: 16860157.

Stoll B.J., Hansen N.I., Bell E.F. et al. Neonatal outcomes of extremely preterm infants from the NICHD Neonatal Research Network. Pediatrics. 2010 Sep. 126(3). 443-456. doi: 10.1542/peds.2009-2959. Epub 2010, Aug 23. PMID: 20732945; PMCID: PMC2982806.

Levesque B.M., Kalish L.A., Winston A.B. et al. Low urine vascular endothelial growth factor levels are associated with mechanical ventilation, bronchopulmonary dysplasia and retinopathy of prematurity. Neonatology. 2013. 104(1). 56-64. doi: 10.1159/000351040. Epub 2013, May 24. PMID: 23711562.

DeLong E.R., DeLong D.M., Clarke-Pearson D.L. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988 Sep. 44(3). 837-845. PMID: 3203132.

Hwang J.H., Lee E.H., Kim E.A. Retinopathy of Prematurity among Very-Low-Birth-Weight Infants in Korea: Incidence, Treatment, and Risk Factors. J. Korean Med. Sci. 2015 Oct. 30 (Suppl 1). 88-94. doi: 10.3346/jkms.2015.30.S1.S88. Epub 2015, Oct 27. PMID: 26566363; PMCID: PMC4641069.

Chang J.W. Risk factor analysis for the development and progression of retinopathy of prematurity. PLoS One. 2019, Jul 18. 14(7). e0219934. doi: 10.1371/journal.pone.0219934. PMID: 31318921; PMCID: PMC6638955.

Hellström A., Smith L.E., Dammann O. Retinopathy of prematurity. Lancet. 2013, Oct 26. 382(9902). 1445-1457. doi: 10.1016/S0140-6736(13)60178-6. Epub 2013, Jun 17. PMID: 23782686; PMCID: PMC4389630.

Published

2021-07-06

Issue

Section

Original Researches