Incidence and risk factors of retinopathy of prematurity in an Italian cohort of preterm infants

Carlo Dani,Domenico Lepore,Caterina Coviello,Giovanni Vento,Simonetta Costa,Fiorenza Panin,Velia Purcaro,Saverio Frosini

doi:10.1186/s13052-021-01011-w

Abstract

ObjectiveNon-negligible differences in retinopathy of prematurity (ROP) and its risk factors between different neonatal intensive care units (NICUs) are reported. Our aim was to assess the incidence and risk factors for ROP development in a large cohort of very preterm infants who were assisted in two Italian NICUs.MethodsPreterm infants with gestational age between 23+ 0 and 29+ 6 weeks were stratified into subgroups of infants who developed ROP and those who did not; their clinical characteristics were compared with univariate and multivariable logistic regression analyses.ResultsWe studied a total of 178 infants of whom 67 (38%) developed ROP (stage 1: n = 12; stage 2: n = 41; stage 3: n = 14). Regression analysis demonstrated that maternal milk (OR 0.979, 95% Cl 0.961–0.998) decreased the risk of developing ROP, while intraventricular hemorrhage (IVH) (OR 2.055, 95% Cl 1.120–3.772) increased it. Moreover, maternal milk was found to decrease (OR 0.981, 95% Cl 0.964–0.997) the risk of ROP at discharge, while RBC transfusion increased it (OR 1.522, 95% Cl 1.208–1.916).ConclusionsIn our cohort the occurrence of ROP was similar to that previously reported. Strategies for promoting the use of mother’s own milk, preventing IVH, and standardizing the approach to RBC transfusions could contribute to decreasing the risk of ROP in very preterm infants.

Highlights

Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder, which is the main cause of visual impairment and blindness in preterm infants [1]
Regression analysis demonstrated that maternal milk decreased the risk of developing ROP, while intraventricular hemorrhage (IVH)
In a recent meta-analysis of five studies [only randomized controlled studies (RCTs)] involving 2208 preterm infants, Zhu et al demonstrated that exclusive human milk versus exclusive formula feeding decreases the risk of any stage and severe ROP, while mainly human milk versus mainly formula feeding decreases the risk of severe ROP [23]

Summary

Introduction

Retinopathy of prematurity (ROP) is a vasoproliferative retinal disorder, which is the main cause of visual impairment and blindness in preterm infants [1]. ROP is a two phase disease with a first phase of reduced retinal vascular growth and loss of blood vessels due to a lack of growth factors and abnormal oxygenation [3, 4]. During this phase, the retina is incompletely vascularized with the development of a peripheral avascular zone which becomes increasingly hypoxic. The retina is incompletely vascularized with the development of a peripheral avascular zone which becomes increasingly hypoxic This hypoxia induces the second phase of ROP characterized by an increase in the expression of the vascular endothelial growth factor (VEGF) which can promote uncontrolled neovascularization and retinal detachment [3, 4].

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