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Michael B Yang, Pia Lundgren, Patricia Cobb, Richard Lang, Lois E H Smith, Chatarina Lofqvist, Ann Hellström; Association of Average Day Length during Early Gestation with Treated Retinopathy of Prematurity in Black Premature Infants: A Multicenter Study.. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):954.
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© ARVO (1962-2015); The Authors (2016-present)
Previous studies suggested the presence of a melanopsin-dependent light response during early gestation in the fetal mouse that affected the subsequent development of retinal neurons and vasculature. Supporting this hypothesis was a single center study that showed lower light exposure during early gestation, estimated by average day length (ADL), was associated with a higher risk of severe retinopathy of prematurity (ROP) warranting surgery. The purpose of this study was to analyze a multicenter cohort of premature infants for an association between ADL during early gestation and treated retinopathy of prematurity (TROP).
In 2090 premature infants (11 centers), multiple logistic regression analysis (MLRA) of predictive variables for an outcome of TROP included ADL during days 61-90 after conception (ADL61-90).
Increasing birth weight & gestational age and black race were associated with a lower likelihood, while male gender was associated with a higher, likelihood of TROP. Multiple birth status was not predictive of outcome. While ADL61-90 was not significantly associated with TROP in the overall population (p=0.104), subgroup analysis for 530 black infants showed that each additional hour of ADL61-90 (range: 8.98 to 15.4 h) was associated with a 31.5 % lower likelihood of developing TROP (Odds Ratio: 0.685, p = 0.003). The addition of WINROP alarm status, a marker of "illness severity", to the MLRA did not eliminate ADL61-90 as a significant predictor.
The association of lower ADL with TROP occurred only in black infants and may be due to greater attenuation of light to a critical threshold of response by the mother's darker skin pigment and/or involvement of a different pathway for light-induced vascular development. Current treatment at the less severe type 1 prethreshold ROP may have masked the previously reported association of lower ADL with more severe ROP, i.e. classic threshold, in a different cohort of infants. There may be a role for light therapy in early gestation to reduce the risk of TROP among black premature infants.
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