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Alexander Port, R.V. Paul Chan, Susan Ostmo, Michael Chiang; Risk factors for retinopathy of prematurity (ROP): insights from “outlier” infants with low or high birth weights. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4947.
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Many risk factors for ROP, such as low birth weight (BW), systemic illness and supplemental oxygen, are known. However, clinicians are often unable to explain “outliers”: large infants with low apparent risk that develop ROP, and small infants with high apparent risk that never develop disease. This project aims to define features of “outlier” infants, with the goal of gaining insight about protective or predisposing factors.
We reviewed infants screened at WCMC and CUMC from 2002-2010. ROP exam results were recorded, along with clinical factors including sex, BW, gestational age, multiple gestation, maternal race, IVF status, mechanical ventilation, bronchopulmonary dysplasia, neonatal sepsis, intraventricular hemorrhage, and necrotizing enterocolitis. The cohort was stratified by weight, highest ROP stage, and need for ROP treatment. Descriptive and correlational statistics were performed.
During the study period, 1377 infants were screened for ROP. For the overall cohort (n=1377), all clinical factors above and Caucasian race were significantly associated with ROP stage and need for laser treatment (p<0.05). Among 258 infants with BW <750g, 78/258 (30%) were “outliers” who developed no ROP. Among 469 infants with BW >1250g, 66/469 (14%) were “outliers” who developed ROP. For “outliers” with BW <750g or >1250g, the only statistically-significant differences between infants with vs. without ROP were in multiple gestation and neonatal sepsis. Among infants with BW < 500g, there were no statistically-significant differences in any clinical risk factors between the 4 (23%) “extreme outliers” without ROP and the 13 (77%) with ROP (Table1). For the 168 with BW >1500g, there were no significant differences in any clinical risk factors between 16 (9%) “extreme outliers” with ROP vs. the 152 (91%) without ROP.
In this large cohort, known clinical risk factors were predictive of ROP stage and need for laser treatment. However, these risk factors were not significantly associated with ROP at extremes of birth weight. This suggests that other clinical, maternal, or genetic factors may protect from or predispose to ROP pathogenesis.
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