Late-onset Circulatory Collapse and Continuous Positive Airway Pressure are Useful Predictors of Treatment-requiring Retinopathy of Prematurity: A 9-year Retrospective Analysis

Mitsuru Arima,Shoko Tsukamoto,Kanako Fujikawa,Koh-Hei Sonoda,Kohta Fujiwara,Miwa Murayama

doi:10.1038/s41598-017-04269-5

Mitsuru Arima, Shoko Tsukamoto + Show 4 more

Open Access

https://doi.org/10.1038/s41598-017-04269-5

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Abstract

sVisual loss caused by retinopathy of prematurity (ROP) will be prevented if treatment-requiring ROP (TR-ROP) can be predicted. In this retrospective study including 418 infants with ≤32 weeks of gestational age (GA) and/or ≤1500 grams of birthweight, we attempted to identify useful predictors. We also examined the efficiency of significant predictors compared with existing predictive models, ROPScore and CHOP model. Multivariable logistic regression analyses supported the following factors were useful for predicting TR-ROP from all infants and infants with any ROP: GA (odds ratio [OR], 0.47 and 0.48), history of late-onset circulatory collapse (LCC) (OR, 2.76 and 2.44) and use of continuous positive airway pressure (CPAP) at 35 weeks of postmenstrual age (OR, 3.78 and 4.50). The comparison of areas under receiver operating characteristic curves indicated the combination of LCC, CPAP and ROPScore was better than ROPScore to predict TR-ROP from all infants and infants with any ROP (P = 0.007 and 0.02) and the combination of LCC, CPAP and CHOP model was also better than CHOP model to predict TR-ROP from all infants and infants with any ROP (P = 0.01 and 0.02). Our results suggested infants with a history of LCC and a long CPAP support have a high incidence of TR-ROP.

Highlights

The results revealed that gestational age (GA) (OR, 0.47; 95% CI, 0.35–0.61; P < 0.0001), a history of late-onset circulatory collapse (LCC) (OR, 2.76; 95% CI, 1.24–6.19; P = 0.01), and the use of continuous positive airway pressure (CPAP) at 35 weeks’ postmenstrual age (PMA) (OR, 3.78; 95% CI, 1.66–8.93; P = 0.002) were independent significant predictors
We set the deadline for judging whether parameters of LCC, sepsis, patent ductus arteriosus (PDA) ligation, transfusion, use history of oxygen, CPAP, intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) were positive to 35 weeks of PMA
The feature of this study to be emphasized most is that a history of LCC was included as the candidate factor for predicting TR-retinopathy of prematurity (ROP)

Summary

Introduction

1. Several days have passed after the resolution of unstable circulatory condition in the acute postnatal phase. 2. Episodes of circulatory collapse as described below have appeared without obvious causes such as sepsis, PDA, hemorrhage, and other causes. Blood pressure Hypotension with ≤ 80% of blood pressure in the previous stable state Urinary volume (a) Oliguria with ≤ 50% of urinary volume in the previous stable state (b) Oliguria with ≤ 1 ml/kg/hr over the past 8 hr (c) Anuria for the past 4 hr (urinary retention is excluded). 3. Administration of glucocorticoid was required because treatment with volume expansion or a vasopressor was inadequate for the improvement of circulatory collapse. Caused by anemia are representative conditions that induce tissue hypoxia. Our purpose in conducting the present study was to identify useful predictors for the development of TR-ROP from the standpoint of retinal hypoxia

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