June 2021
Volume 62, Issue 8
Open Access
ARVO Annual Meeting Abstract  |   June 2021
Sepsis and Necrotizing Enterocolitis are Associated with Thinner Retinal Nerve Fiber Layer in Preterm Infants at 36 Weeks Postmenstrual Age
Author Affiliations & Notes
  • Liangbo Linus Shen
    Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, Connecticut, United States
  • Shwetha Mangalesh
    Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Suzanne Michalak
    Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Brendan McGeehan
    Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Neeru Sarin
    Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Joanne Finkle
    Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States
  • Eric J Benner
    Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States
  • Noelle Younge
    Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States
  • C. Michael Cotten
    Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States
  • Lejla Vajzovic
    Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Sharon F Freedman
    Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
    Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, United States
  • Mays El-Dairi
    Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Gui-Shuang Ying
    Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Cynthia A Toth
    Department of Ophthalmology, Duke University School of Medicine, Durham, North Carolina, United States
  • Footnotes
    Commercial Relationships   Liangbo Shen, None; Shwetha Mangalesh, None; Suzanne Michalak, None; Brendan McGeehan, None; Neeru Sarin, None; Joanne Finkle, None; Eric Benner, None; Noelle Younge, None; C. Cotten, None; Lejla Vajzovic, Heidelberg Engineering (F); Sharon Freedman, None; Mays El-Dairi, None; Gui-Shuang Ying, None; Cynthia Toth, Alcon Laboratories, Inc. (P), EMMES (C), National Eye Institute and Research to Prevent Blindness (F), Theia Imaging, LLC (I)
  • Footnotes
    Support  NIH Grant R01 EY025009
Investigative Ophthalmology & Visual Science June 2021, Vol.62, 2736. doi:
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      Liangbo Linus Shen, Shwetha Mangalesh, Suzanne Michalak, Brendan McGeehan, Neeru Sarin, Joanne Finkle, Eric J Benner, Noelle Younge, C. Michael Cotten, Lejla Vajzovic, Sharon F Freedman, Mays El-Dairi, Gui-Shuang Ying, Cynthia A Toth; Sepsis and Necrotizing Enterocolitis are Associated with Thinner Retinal Nerve Fiber Layer in Preterm Infants at 36 Weeks Postmenstrual Age. Invest. Ophthalmol. Vis. Sci. 2021;62(8):2736.

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Abstract

Purpose : Neonatal insults from systemic diseases have been implicated in the pathway of impaired neurodevelopment in preterm infants. Thinner retinal nerve fiber layer (RNFL) assessed by optical coherence tomography (OCT) has been associated with poorer neurodevelopment in preterm infants, suggesting RNFL thickness may reflect the brain as a whole in preterm infants. However, it remains unknown if RNFL thickness can serve as a noninvasive biomarker for the impact of systemic diseases on the central nervous system in preterm infants. We aimed to investigate associations between systemic health factors and RNFL thickness in preterm infants.

Methods : The STudy of Eye imaging in Preterm infantS (BabySTEPS) prospectively enrolled infants eligible for retinopathy of prematurity screening based on standard guidelines. We imaged both eyes of these infants at 36 ± 1 weeks postmenstrual age (PMA) using a handheld OCT system at the bedside in the Duke intensive care nurseries. RNFL thickness of the right and left eyes was averaged for each infant. We evaluated associations between RNFL thickness and 27 systemic health factors using multivariable regression models.

Results : We included 83 infants with RNFL thickness measures in this study. Of the 83, 16 infants had sepsis or necrotizing enterocolitis (NEC).These events occurred before the OCT imaging (time interval = 50 ± 22 days). Among 27 systemic factors, infant weight at imaging and sepsis/NEC were independently associated with RNFL thickness. RNFL was 10.4 μm thinner in infants with sepsis/NEC than without sepsis/NEC (52.7±9.0 vs. 63.1±10.2 μm; P < 0.001). This difference remained statistically significant after adjustment for confounding variables (birth weight, birth weight percentile, gestational age, infant weight at OCT imaging, and growth velocity). A 250-g increase in infant weight at OCT imaging was associated with a 3.1 μm (95%CI = 2.1 to 4.2) increase in RNFL thickness (P < 0.001).

Conclusions : Low infant weight and sepsis/NEC were independently associated with thinner RNFL in preterm infants at 36 weeks PMA. To our knowledge, this study is the first to suggest that sepsis/NEC may affect retinal neurodevelopment. OCT-measured RNFL may offer a noninvasive biomarker to assess the negative impact of sepsis/NEC on the central nervous system in preterm infants.

This is a 2021 ARVO Annual Meeting abstract.

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