Association of Hyperglycemia with the Development of Retinopathy of Prematurity

Abstract

Abstract: : Purpose: Premature infants are known to have defects in glucose homeostasis resulting in hyperglycemia (glucose >125mg/dl) during the neonatal period. This study was designed to investigate the prevalence and severity of hyperglycemia in two groups of premature infants: those who developed threshold retinopathy of prematurity (ROP) and those who did not develop ROP. Methods: A retrospective chart review was performed on 53 premature infants who received screening eye exams for ROP. Of these 53 infants, 25 did not develop ROP (Group A) and 28 developed threshold ROP requiring laser treatment (Group B). Maximum daily serum or whole blood glucose concentrations (BGC) were recorded. Statistical analysis of gestational age, birthweight, incidence of sepsis, number of days of mechanical ventilation, and BGC was performed. Results: No statistical difference was observed in gender or race distribution between the two groups. In Group A, 14 of 25 infants became hyperglycemic whereas all 28 infants in Group B became hyperglycemic during the neonatal period. Of those who were hyperglycemic, the average BGC at onset of hyperglycemia was 158 mg/dl for Group A compared to 235 mg/dl for Group B (P < 0.005). The median BGC was calculated for each infant. For Group A, the average median BGC was 99mg/dl compared to 138mg/dl for Group B (P < 0.0001). Calculation of odds ratios indicated that Group B was 3.9 times more likely to have BGC > 125 mg/dl (P < 0.0002), 4.6 times more likely to have BGC > 200 (P < 0.006), and 13.3 times more likely to have septic events (P < 0.0004). Statistical analysis of generally accepted risk factors for ROP revealed that Group B compared to Group A had significantly lower mean birthweight (686 vs 1320g), lower mean gestational age (25 vs 30 wks), and greater number of days on mechanical ventilation (76 vs 12 days). Conclusions: Hyperglycemia is more prevalent and more severe in premature infants who develop ROP than in those who do not develop ROP. In order to determine if hyperglycemia is a contributing factor in the development of ROP, further evaluation controlling for birthweight and gestational age is needed.

Keywords: retinopathy of prematurity