The Effect of Perinatal Steroids on the Severity of ROP

Abstract

Abstract: : Purpose:To evaluate the effect of perinatal administration of steroids on the severity of retinopathy of prematurity (ROP) Methods: We conducted a retrospective chart review of premature infants seen in the neonatal intensive care unit of the John H. Stroger, Jr. Hospital of Cook County from 1997–2003. A total of 1093 charts were reviewed. Data from 870 charts were analyzed with 223 charts having insufficient data for analysis. All premature infants were dilated and examined by the attending (PBD) or senior resident. The premature infants were grouped into 4 birth weight categories: less than 750grams (n=101), 750g to 999grams (n=203) , 1000g–1250grams (n=147), and those greater than 1250grams (n=419). A numerical value was assigned to retinal blood vessel development and zones for purposes of statistical analysis: 0=mature, 1=immature, 2= stage 1, 3=stage 2 and 4=stage 3; 1=zone I, 2=zone II, 3=zone III, 4=mature. The infants were further divided into 2 groups: those receiving steroids and those not receiving steroids. Both antenatal steroids, used in single two–injection doses, and postnatal steroids, systemic intravenous corticosteroid therapy, were grouped together in the steroid group. Results: Using numerical values described in the methods, a mean value score of stage or zone was established for each grouping controlled for birth weight and gestational age. Higher value scores represented higher stages and lower zones. For babies less than 750 grams there was no difference in stage or of zone between the steroid and no steroid groups (p=0.9556). In the 750–999 gm group and the 1000–1250gm groups there was a statistically significant risk of higher stage ROP in the steroid treated group with no difference in zones (p=0.0232, p=0.0044). In the greater than 1250gm group, there was no statistically significantly different risk in ROP stage or zone between the steroid and no steroid group (p=0.7978). Conclusions:Our study findings suggest that high dose perinatal steroid use may promote more severe stages of ROP in babies with birth weights between 750 and 1250 grams. The anecdotal increase in ROP severity noted by some is not a result of the changing pattern of steroid use in the NICU per our study results. The decrease in steroid use in the last several years should have resulted in less severe ROP disease on average. Other factors are needed to explain the observed phenomenon. The neonatologist should not consider the withholding of perinatal steroids a risk factor for severe ROP.

Keywords: retinopathy of prematurity • clinical (human) or epidemiologic studies: outcomes/complications • retina