Abstract
Purpose :
Neonatal sepsis is an independent risk factor for retinopathy of prematurity (ROP). However, studies on the association between neonatal sepsis and ROP have predominately focused on late-onset sepsis (LOS) (>72 hours of life). Since studies have shown that placental inflammation/infection through vertical transmission leads to an increased risk of ROP, we hypothesize that early-onset sepsis (EOS) (<72 hours of life) is an independent risk factor for ROP. Hence, we explored the association between EOS and the risk of ROP in premature neonates.
Methods :
This meta-analysis included 29 studies (2007-2002) reporting on the incidence of EOS (suspected and/or proven) in neonates with ROP. Subgroup analysis was performed for neonates with proven EOS (i.e. positive blood or cerebrospinal fluid culture). PubMed, EMBASE and Cochrane Library were searched in October 2022. Observational studies were included when unadjusted data was reported on EOS in neonates with ROP. Logistic random-effects models were used due to anticipated heterogeneity and tested the association between EOS and ROP. Meta-regression models were performed to explain observed heterogeneity. The Bonferroni correction for multiple comparisons was used to account for multiple testing.
Results :
Neonates with EOS had a significantly increased risk for any stage ROP (OR 2.1; 95% CI 1.3-3.4) and severe ROP (OR 2.3; 95% CI 1.9-2.8) compared to neonates without EOS. Severe ROP was found more frequently in neonates with proven EOS (OR 2.3; 95% CI 1.5-3.4). Univariate meta-regression analysis suggests that higher effect sizes between EOS and severe ROP are found in neonates with increased rates of LOS and necrotising enterocolitis.
Conclusions :
This is the first meta-analysis demonstrating the association between EOS and ROP. Part of the found effect may be influenced by multiple exposure to inflammation following increased LOS and necrotising enterocolitis rates found in severe ROP cases. Ophthalmologists and neonatologists need to be aware that EOS is a luxating factor for ROP. EOS can be a tool to target high-risk infants in an earlier stage than the current 5-7 weeks and possibly prevent progression to severe visual impairment and blindness.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.