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Mohamed A. Hussein, David K. Coats, Humair Khan, Evelyn Paysse, Paul Steinkuller, Lingkun Kong; Evaluating The Association Of Autonomic Drug Use In The Development and Severity Of Retinopathy Of Prematurity. Invest. Ophthalmol. Vis. Sci. 2012;53(14):5869.
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To explore the association of autonomic agents, presumed to regulate the ocular perfusion, in the development and severity of retinopathy of prematurity.
We reviewed the charts of infants screened for retinopathy of prematurity at our institution in the years 2009 and 2010. We included in the study infants that had been treated with autonomic agents during their stay in the NICU.Multiple logistic regression analysis was used to assess the association between the development and severity of ROP and the use and dose(s) of autonomic agents, after adjustment for covariates (the estimated gestational age and weight of the infants, and development of septicemia, intraventricular hemorrhage, or Respiratory Distress Syndrome).
350 infants were included in the study. The commonest autonomic agents used were Caffeine (n=333) and Dopamine (n=93).After Adjustment, there was a significant association between the use of dopamine and the need for laser treatment [P=0.001, Odds ratio= 5.96 (95% CI from 2.14 to 16.61)] and development of ROP [P= 0.001, Odds ratio = 3.2 (95% CI from 1.7 to 6.2)]. For infants using dopamine, after adjustment, the estimated percentage of infants needing laser treatment was 10 % (95% CI from 1% to 19%) and for those developing ROP was 47% (95% CI from 31% to 64%).For infants not using dopamine, after adjustment, the estimated percentage of infants needing laser treatment was 2% (95% CI from 0 to 4%) and for those developing ROP was 22% (95% CI from 12% to 31%).After adjustment, the number of dopamine doses was significantly associated with the need for laser treatment [P=0.002, Odds ratio= 1.3 (95% CI from 1.08 to 1.42)], the development of any ROP [P= 0.001, Odds ratio 1.28, (95% CI from 1.01 to 1.48)], and the development of severe ROP [P=0.001, Odds ratio 1.27 (95% CI from 1.11 to 1.45)]. Each unit increase in the dopamine dose was associated with 24% increase in the odds of the need for laser treatment and 27% increase in the odds of development of any ROP and in the development of severe ROP.After adjustment, Caffeine dose was significantly associated with the need for laser treatment ([P=0.03, Odds ratio=1.002 (95% CI from 1.000 to 1.003), and the development of any ROP [p= 0.025, Odds ratio= 1.001 (95% CI from 1.000 to 1.003)]. Each 50 units increase in the dose was associated with 9% increase in the odds for laser treatment and 5% increase in the Odds of development of ROP.
The use of the autonomic agents, Caffeine and Dopamine, was strongly associated with the development and severity of retinopathy of prematurity. While a causal relationship has not been established, autonomic agents may play an important role in the development of retinopathy of prematurity.
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