Birth weight, gestational age, and duration of supplemental
oxygen have been found to be the leading risk factors for retinopathy
of prematurity (ROP).
1 2 3 4 5 Corticosteroid treatment has
been used with increasing frequency in neonatology. Antenatal
corticosteroid administration is now a recommended treatment to promote
lung maturity in premature delivery at gestational ages of 24 to 34
weeks.
6 Higgins et al.,
7 Kennedy,
8 and the Italian ROP study,
9 reported decreasing severity of ROP in infants born to mothers who had
received antenatal steroid treatment. Postnatal administration of
corticosteroids has also been studied extensively with the goal of
decreasing the incidence of chronic lung disease, duration of
mechanical ventilation, and supplemental oxygen
requirement.
10 There are still no clear-cut guidelines for
postnatal administration of steroids. With some, treatment begins as
early as 24 hours after birth and with others, after 2 to 3 weeks of
life. Results are controversial. ROP has also been evaluated after
postnatal corticosteroid therapy, because it has anti-inflammatory and
angiostatic effects. At least four studies
11 12 13 14 have
focused on the association between corticosteroid treatment and ROP,
with contradictory results. Wright and Wright
11 reported
that there is no association, Sobel and Philip
12 demonstrated that prolonged use of steroids beginning on a mean of day
23 after birth reduces the need for cryotherapy, and Batton et
al.
13 and Ramanathan et al.
14 both reported
that postnatal steroid therapy is associated with severe ROP and
requirement for cryotherapy. Regression analyses to control for degree
of systemic illness of preterm infants were performed and confirmed no
association with ROP
11 12 and, in contrast, a significant
increase in risk
13 for ROP in infants treated with
dexamethasone.