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Choi, Han, Kim, Kim, and Jeon: The Most Important Factors for Retinopathy of Prematurity in Preterm Infants
Original Article

Korean J Perinatol 2014;25(3):153-158.

Published online: 21 September 2014

DOI: https://doi.org/10.14734/kjp.2014.25.3.153

The Most Important Factors for Retinopathy of Prematurity in Preterm Infants

Ji Yeon Choi, M.D.1, Young Ik Han, M.D.1, Ji Hee Kim, M.D.2, Eun Sun Kim, M.D.2, Jihyun Jeon, M.D.2

1Department of Pediatrics, Bundang CHA Medical Center, CHA University School of Medicine, Seongnam, Korea

2Department of Pediatrics, Gangnam CHA Medical Center, CHA University School of Medicine, Seoul, Korea

Correspondence: Jihyun Jeon, M.D. Department of Pediatrics, Gangnam CHA Medical Center, CHA University School of Medicine, 569, Nonhyon-ro, Gangnam-gu Seoul 135-081, Korea Tel : +82-2-3468-2643, Fax : +82-2-3468-3000 E-mail : g-daughter@hanmail.net

Received 7 July 20148 August 2014       Accepted 27 August 2014

Copyright © 2014 Korean Society of Perinatology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

There are many known risk factors for a retinopathy of prematurity (ROP). We analyzed the most important risk factors and predictors of ROP among them.

Methods

We retrospectively reviewed the medical records of all premature infants admitted to the neonatal intensive care unit (NICU), between January 2010 and December 2012 at Gangnam CHA Medical Center, Seoul. All infants (n=185) were hospitalized for more than 28 days, received eye examination for ROP and showed one of the following criteria: birth weight (BW) below 1,500 g, gestational age (GA) below 32 weeks, or oxygen treatment (≥40% oxygen for more than 3 days). We divided the infants into the Non-ROP group (n=162) and the ROP group (n=23, more than stage 1) and analyzed group comparisons, risk factors and the importance of each factor of ROP by SPSS 13.0.

Results

Risk factors were duration of oxygen uses [Odds ratio (OR): 1.064, 95% confidence interval (CI): 1.007-1.125, P=0.028] and intravenous (IV) steroid (OR: 1.234, 95% CI: 1.000-1.523, P=0.049) by multifactor adjustment. The most important factor was oxygenation duration. The following factors were time to full enteral feedings, and IV steroid duration.

Conclusion

The incidence of ROP will be decreased if we can reduce the length of oxygen uses, IV steroid use and advance the full feeding achievement.

Keywords: Retinopathy of prematurity, Risk factor, Oxygen, Enteral feeding, Steroid

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Table 1.
Clinical characteristics of VLBW infants
Non-ROP (n=162) ROP (n=23) P-value
GA (weeks) 31.4±2.2 28.8±2.0 0.000
BW (g) 1,648.1±411.7 1,232.2±346.4 0.000
Male (n) 96 (59%) 12 (52%) NS
APGA at 1-minute 4.8±1.7 3.8±2.0 0.033
APGA at 5-minute 6.6±1.4 5.7±1.7 0.018
Platelet count (103⁄μL) 223.1±60.2 215.7±58.7 NS
Proven sepsis (n) * 4 (3%) 3 (13%) NS
RDS (n) 115 (71.0) 22 (95.7) 0.000
PDA (n) 39 (24%) 8 (35%) NS
NEC (n) 12 (7%) 5 (22%) NS
IVH (n) 71 (44%) 9 (39%) NS
BPD (n) 10 (6%) 4 (18%) NS
RBC transfusion (n) 1.4 (1.8%) 3.4 (2.2%) 0.000
IV steroid (d) 0.9±2.0 3.0±4.2 0.028
Ventilator treatment (d) 4.8±7.7 11.7±11.6 0.011
Oxygen uses (d) 15.9±14.0 41.1±22.6 0.000
TPN (d) 22.0±13.4 32.2±14.1 0.003
Day of full feeding (d) 26.3±13.4 33.9±14.4 0.025
Hospital day (d) 41.2±16.8 51.4±19.4 0.008

* Including blood culture positive

Abbreviations: VLBW, very low birth weight; ROP, retinopathy of prematurity; GA, Gestational age; BW, Birth weight; APGA, apgar score; RDS, Respiratory distress syndrome; PDA, Patent ductus arteriosus; NEC, Necrotizing enterocolitis; IVH, Intraventricular haemorrhage; BPD, Bronchopulmonary dysplasia; RBC, Red blood cell; IV, Intravenous; TPN, Total parenteral nutrition, NS, non-significant

Values are expressed as number (percent) or mean±standard deviation

Table 2.
Maternal and obstetric factors and comparison of variables
Non-ROP (n = 162) ROP (n = 23) P-value
Clinical chorioamnionitis 69 (43%) 11 (42%) NS
PROM 53 (33%) 12 (52%) 0.067
Preeclampsia 35 (22%) 3 (13%) NS
Multiple births 72 (44%) 14 (61%) NS
IVF 59 (36%) 7 (30%) NS
Antenatal betamethasone 109 (68%) 14 (61%) NS

Abbreviations: ROP, retinopathy of prematurity; PROM, Premature rupture of membranes; IVF, In vitro fertilization; NS, nonspecific Values are expressed as number (percent)

Table 3. The odds ratio of retinopathy of prematurity by logistic regression
Variable Odds ratio 95% CI P-value
GA 0.742 0.443–1.242 0.257
BW 0.999 0.996 –1.002 0.390
RBC transfusion 0.377 0.051–2.816 0.342
IV steroid 1.234 1.000–1.523 0.049
Duration of oxygen uses 1.064 1.007–1.125 0.028
Full feeding day 1.043 0.958–1.137 0.333

Adjustment factors: APGA at 1 min and 5 min, RDS, TPN Abbreviations: CI, confidence interval; GA, gestational age; BW, Birth weight; RBC, red blood cell; IV, intravenous; APGA, apgar score; RDS, respiratory distress syndrome; TPN, Total parenteral nutrition

Table 4.
The importance of risk factors of retinopathy of prematurity
Independent variable Importance Normalized importance
Oxygen Duration .072 100.0%
Full Feeding .063 88.2%
IV Steroid .042 59.4%
GA .025 34.3%
RBC transfusion .017 23.2%
APGA at 5 min .003 4.6%
APGA at 1 min .002 2.3%

Growing Method: CRT Dependent Variable: Presence or absence of ROP Abbreviations: IV, intravenous; GA, gestational age; RBC, red blood cell; APGA, apgar score

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