Abstract
Abstract: :
Purpose:A considerable progress has been made in survival of very low birth (VLBW) neonates (<1250g), but retinopathy of prematurity (ROP) continues as one of the major causes of morbidity. The purpose of the present study was to investigate the contribution of hyperglycemia as a risk factor for ROP in VLBW neonates. Methods:A retrospective cross–sectional study of 207 VLBW infants born between 1990–1999 at NY Methodist Hospital was performed. A computerized database was constructed of all valid data extracted from medical charts. Management protocol required that the daily glucose intake be adjusted to maintain glucose levels of <120mg/dL to a maximum of 23.9 g/kg/day. A minimum and maximum level for each day during the first 28 postnatal days was used to compute the mean maximum for each neonate. A low mean airway pressure (MAP) was used to maintain PaCO 2 in the high normal range. Potential risk of gestational age (GA), birth weight (BW) and the need for suplemental oxygen and ventilation were also evaluated. The results of cranial ultrasound and detailed ophthalmologic exams were available for each neonate. Results:Neonates who developed ROP (9.1%) were of lower GA and lower BW (GA:26.1 vs 27.0 wks; p=0.0003; BW:781.3 vs 944.3 g; <0.0001). Proportion of neonates in whom hyperglycemia could not be controlled was higher in the ROP group (36.8% vs 0.5%; p<0.0001). The average maximum glucose levels during the 28 postnatal days were higher in neonates with ROP (p<0.0001). MAP was similar in both groups. Neonates with ROP required supplemental oxygen 2 weeks longer than neonates without ROP (9.0 vs7.2 wks; p=0.04). Intraventricular hemmorhage was diagnosed in 8 (42%) of neonates with ROP, but was mostly (75%) Grade 1. Conclusions:In addition to low gestational age, low birthweight, a need for longer oxygen supplementation and the presence of IVH, hyperglycemia presents a major risk for ROP in VLBW neonates.
Keywords: retinopathy of prematurity • clinical (human) or epidemiologic studies: risk factor assessment • infant vision