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Czeszyk A, Hautz W, Bulsiewicz D, Jaworski M, Czech-Kowalska J. The long-term influence of perinatal factors on macular morphology and vessel density in preterm children. Early Hum Dev 2024; 192:105993. [PMID: 38643639 DOI: 10.1016/j.earlhumdev.2024.105993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/22/2024] [Accepted: 03/23/2024] [Indexed: 04/23/2024]
Abstract
BACKGROUND Increased survival rate of extremely preterm children is associated with a higher risk of retinopathy of prematurity (ROP) and long-term sequelae, which implicate retinal changes. PURPOSE To assess an influence of perinatal characteristics on morphology and retinal vascularity of the macula in preterm children. METHODS A cohort of 123 preterm children at the age of 10.5 years (IQR: 8.12-12.77) was prospectively assessed. Optical coherence tomography angiography (OCTA) was performed using RTVueXR Avanti. Foveal thickness, parafoveal thickness, size of foveal avascular zone (FAZ), superficial and deep vessel density, central choroidal thickness (CCT) were analyzed. The associations between OCTA results and perinatal factors, including the presence of ROP and therapy requirements were assessed in preterm children. RESULTS Significantly smaller FAZ, higher foveal thickness and vessel density were noted in children with ROP, Respiratory Distress Syndrome, Bronchopulmonary Dysplasia, required erythropoietin, transfusion or steroids. Foveal thickness was increased in children with ROP (p < 0.001) and following laser treatment (p < 0.05). Thinner CCT was noted in children with a history of sepsis (p < 0.05) and ROP required treatment (p < 0.05). Pregnancy bleeding was associated with higher superficial foveal vessel density (p < 0.05) and smaller FAZ (p < 0.05). CONCLUSION Neonatal factors have a huge impact on retinal development, but the role of prenatal factors should not be neglected in preterm children.
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Affiliation(s)
- Agnieszka Czeszyk
- Department of Ophthalmology, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
| | - Wojciech Hautz
- Department of Ophthalmology, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
| | - Dorota Bulsiewicz
- Department of Neonatology and Neonatal Intensive Care, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
| | - Maciej Jaworski
- Department of Biochemistry, Radioimmunology and Experimental Medicine, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
| | - Justyna Czech-Kowalska
- Department of Neonatology and Neonatal Intensive Care, The Children's Memorial Health Institute, 04-730 Warsaw, Poland.
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Kohbodi GA, Cayabyab RG, Kibe RN, Ebrahimi M, Barton L, Uzunyan MY, Ramanathan R. Effect of Maternal Preeclampsia on Cardiac Structure and Function in Very Low Birth Weight Infants. Am J Perinatol 2024; 41:e3413-e3419. [PMID: 38266754 DOI: 10.1055/s-0044-1779254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE We aimed to determine whether exposure to severe maternal preeclampsia (PE) in very low birth weight (VLBW) infants is associated with hypertrophic cardiac changes and altered hemodynamics. STUDY DESIGN Case-control study of VLBW infants born at Los Angeles General Medical Center from May 2015 to August 2023, who had an echocardiogram within the first 7 days of life. Cases were infants exposed to maternal PE and controls were infants not exposed to maternal PE matched by birth weight (BW) 1:1. Laboratory, placental pathology results, hemodynamic data and clinical outcomes were collected and compared between cases and control infants. RESULTS A total of 43 cases matched by BW with control infants were studied. There were no significant anatomical cardiac changes by echocardiography between cases and control infants. Cases had significantly higher blood pressure within the first 72 hours of life and lower ejection fraction (EF), fractional shortening, and peak systolic flow velocity through their patent ductus arteriosus (PDA) within the first week of life. Cases were more likely to be smaller despite being born at a later gestational age (GA), as well as small for GA with placental weight less than 10th percentile compared to control infants. CONCLUSION Our findings indicate that infants born to mothers with PE have higher systemic vascular resistance as evidenced by elevated blood pressure, and lower EF and shortening fraction and higher pulmonary vascular resistance as evidenced by lower peak flow velocity through the PDA. We did not observe hypertrophic cardiac changes in exposed infants. These findings should be considered in clinical decision-making during management of these infants. KEY POINTS · VLBW infants exposed to severe PE have higher rate of Small for gestational age and smaller placentas.. · VLBW infants exposed to severe PE have higher systemic vascular resistance during transitional period and lower EF and fractional shortening.. · VLBW infants exposed to severe PE have higher pulmonary vascular resistance..
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Affiliation(s)
- GoleNaz A Kohbodi
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rowena G Cayabyab
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rutuja N Kibe
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Mahmoud Ebrahimi
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Lorayne Barton
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Merujan Y Uzunyan
- Division of Cardiology, Department of Pediatrics, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
| | - Rangasamy Ramanathan
- Division of Neonatology, Los Angeles General Medical Center, Keck School of Medicine of University of Southern California, Los Angeles, California
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Abstract
Retinopathy of prematurity (ROP) is a complex disease involving development of the neural retina, ocular circulations, and other organ systems of the premature infant. The external stresses of the ex utero environment also influence the pathophysiology of ROP through interactions among retinal neural, vascular, and glial cells. There is variability among individual infants and presentations of the disease throughout the world, making ROP challenging to study. The methods used include representative animal models, cell culture, and clinical studies. This article describes the impact of maternal-fetal interactions; stresses that the preterm infant experiences; and biologic pathways of interest, including growth factor effects and cell-cell interactions, on the complex pathophysiology of ROP phenotypes in developed and emerging countries.
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Systemic Cytokines in Retinopathy of Prematurity. J Pers Med 2023; 13:jpm13020291. [PMID: 36836525 PMCID: PMC9966226 DOI: 10.3390/jpm13020291] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/09/2023] Open
Abstract
Retinopathy of prematurity (ROP), a vasoproliferative vitreoretinal disorder, is the leading cause of childhood blindness worldwide. Although angiogenic pathways have been the main focus, cytokine-mediated inflammation is also involved in ROP etiology. Herein, we illustrate the characteristics and actions of all cytokines involved in ROP pathogenesis. The two-phase (vaso-obliteration followed by vasoproliferation) theory outlines the evaluation of cytokines in a time-dependent manner. Levels of cytokines may even differ between the blood and the vitreous. Data from animal models of oxygen-induced retinopathy are also valuable. Although conventional cryotherapy and laser photocoagulation are well established and anti-vascular endothelial growth factor agents are available, less destructive novel therapeutics that can precisely target the signaling pathways are required. Linking the cytokines involved in ROP to other maternal and neonatal diseases and conditions provides insights into the management of ROP. Suppressing disordered retinal angiogenesis via the modulation of hypoxia-inducible factor, supplementation of insulin-like growth factor (IGF)-1/IGF-binding protein 3 complex, erythropoietin, and its derivatives, polyunsaturated fatty acids, and inhibition of secretogranin III have attracted the attention of researchers. Recently, gut microbiota modulation, non-coding RNAs, and gene therapies have shown promise in regulating ROP. These emerging therapeutics can be used to treat preterm infants with ROP.
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Neonatal outcomes of twins <29 weeks gestation of mothers with hypertensive disorders of pregnancy. Pediatr Res 2022; 92:748-753. [PMID: 35383262 DOI: 10.1038/s41390-022-02044-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 12/17/2021] [Accepted: 03/01/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Hypertensive disorders of pregnancy (HDP) are associated with dysfunctional placentation and are a major cause of maternal and neonatal morbidity and mortality. Twin pregnancies have a larger placental mass and are a risk factor for HDP. The effect of HDP on neonatal outcomes in twin pregnancies is unknown. METHODS Retrospective cohort study using the Canadian Neonatal Network database from 2010-2018 of twin infants <29 weeks gestation born to mothers with HDP and normotensive pregnancies. Using multivariable models, we determined adjusted odds ratios (AORs) and 95% confidence intervals (CI) for mortality, bronchopulmonary dysplasia, severe neurologic injury, severe retinopathy of prematurity (ROP), necrotizing enterocolitis, and nosocomial infection in twin infants of mothers with HDP compared to twin infants of normotensive mothers. RESULTS Of the 2414 eligible twin infants <29 weeks gestational age, 164 (6.8%) were born to mothers with HDP and had higher odds of severe ROP (AOR 2.48, 95% CI 1.34-4.59). Preterm twin infants born to mothers with HDP also had higher odds of mortality (AOR 2.02, 95% CI 1.23-3.32). There was no difference in other outcomes. CONCLUSION Preterm twin infants <29 weeks gestation of HDP mothers have higher odds of severe ROP and mortality. IMPACT Hypertensive disorders of pregnancy, associated with placental dysfunction, are a major cause of maternal and neonatal morbidity and mortality. Twin pregnancy, associated with a larger placental mass, is a risk factor for hypertensive disorders of pregnancy. The effect of hypertensive disorders of pregnancy on outcomes of preterm twins is unknown. Preterm twins of mothers with hypertensive disorders of pregnancy are at higher risk of severe retinopathy of prematurity and mortality. Our data can be used to counsel parents and identify infants at higher risk of severe retinopathy of prematurity and mortality.
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Zeng Y, Ge G, Lei C, Zhang M. Beyond Fetal Immunity: A Systematic Review and Meta-Analysis of the Association Between Antenatal Corticosteroids and Retinopathy of Prematurity. Front Pharmacol 2022; 13:759742. [PMID: 35153772 PMCID: PMC8832004 DOI: 10.3389/fphar.2022.759742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Retinopathy of prematurity (ROP) is a major cause of childhood blindness. Antenatal corticosteroids (ACS) exposure is known to ameliorate the risk of and mortality of neonatal morbidities. However, the effect of ACS on ROP development is currently unknown. We conducted a meta-analysis with up-to-date evidence to assess the association between ACS exposure and the development of ROP in at-risk preterm infants.Methods: PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library were systematically searched from inception to May 2021, supplemented with manual search from reference lists. Studies with a control group reporting ROP rate in ACS-exposed infants were included. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated utilizing a random-effects model. The Newcastle-Ottawa Scale was used for assessment of risk of bias in the included studies. Meta-regressions were performed to explore the predictive role of confounders for between-study variance.Results: A total of 63 studies, involving 196,264 infants, were included. Meta-analysis showed ACS exposure was not associated with ROP occurrence (uOR 0.92, 95% CI 0.80–1.07; aOR 0.87, 95% CI 0.7–1.08). Results from extremely immature subgroups revealed significant reduced risks of ROP occurrence in ACS-exposed infants. ACS exposure was associated with significantly lower odds of ROP progression in adjusted analysis (aOR 0.48, 95% CI 0.26–0.89) instead of unadjusted analysis (uOR 0.86, 95% CI 0.68–1.08). Meta-regression showed birth weight and patent ductus arteriosus of the cohort were associated with ROP occurrence, sample size and study design strongly associated with ROP progression in ACS-exposed infants.Conclusion: ACS treatment may decrease, but not prevent, the severity of ROP. Findings from severe ROP should be interpreted with caution owing to limited studies and the possibility of false-positive results. Considering the particular benefits in extremely immature infants, we recommend routine usage of ACS in mothers with threatened delivery to this particular birth cohort to prevent ROP occurrence. Future studies adjusting for major confounders are warranted to mitigate risk of bias in such observational evidence.
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Affiliation(s)
- Yue Zeng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Ge Ge
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Chunyan Lei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
| | - Meixia Zhang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, China
- Research Laboratory of Macular Disease, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Meixia Zhang,
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Ge G, Zhang Y, Zhang M. Pregnancy-induced hypertension and retinopathy of prematurity: a meta-analysis. Acta Ophthalmol 2021; 99:e1263-e1273. [PMID: 33611839 DOI: 10.1111/aos.14827] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 02/08/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Retinopathy of prematurity (ROP), one of the leading causes of childhood blindness, is a complex condition in which various antenatal and neonatal factors participate at different stages of the disease. This meta-analysis was conducted to investigate whether pregnancy-induced hypertension (PIH) was associated with ROP by summarizing all available evidence. METHODS PubMed, EMBASE, Web of Science, EBSCO and SCOPUS databases were searched for all relevant studies published from inception to April 2020. Studies investigating the association between PIH and ROP were included. RESULTS A total of 29 studies were finally included for the meta-analysis after study selection. The results showed there are both no significant association between PIH and the occurrence of ROP in case-control studies (OR 0.91, 95%CI 0.59 to 1.40, I2 = 81%, p = 0.67) and cohort studies (OR 1.32, 95%CI 0.89 to 1.98, I2 = 93%, p = 0.17). The conclusion was same between pre-eclampsia and ROP (OR 0.82, 95%CI: 0.50 to 1.35, I2 = 83%, p = 0.43 in case-control studies and OR 1.70, 95%CI: 0.82 to 3.50, I2 = 95%, p = 0.15 in cohort studies). CONCLUSION In summary, this meta-analysis did not reveal a consistent result, the conclusion remains inconclusive, and further studies will be needed to come to a conclusion for the effect of maternal PIH on ROP and foster a better understanding of the prevention of ROP.
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Affiliation(s)
- Ge Ge
- Macular Disease Research Laboratory Department of Ophthalmology West China Hospital of Sichuan University Chengdu China
| | - Yun Zhang
- Macular Disease Research Laboratory Department of Ophthalmology West China Hospital of Sichuan University Chengdu China
| | - Meixia Zhang
- Macular Disease Research Laboratory Department of Ophthalmology West China Hospital of Sichuan University Chengdu China
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Badeeb N, Raffa L, AhmedHussain H, Bamefleh D, Mgharbil E, Alessa S, Alamri A, Albahiti M. Retinopathy of prematurity in Saudi Arabia: Exploring maternal risk factors. Taiwan J Ophthalmol 2021; 11:359-366. [PMID: 35070664 PMCID: PMC8757521 DOI: 10.4103/tjo.tjo_72_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/24/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE: Retinopathy of prematurity (ROP) is a preventable blinding disorder affecting preterm infants. To date, maternal risk factors have not been studied in Saudi Arabia. This study aims to identify possible maternal risk factors for any stage and type 1 ROP. MATERIALS AND METHODS: A total of 295 preterm infants screened for ROP between November 2013 and December 2018 at a Saudi Arabian tertiary-care hospital were included. We included infants with a gestational age ≤ 32 weeks and/or birth weight (BW) ≤1500 g. We analyzed 28 maternal and neonatal risk factors. RESULTS: The incidence of ROP at any stage and Type 1 were 31.9% and 7%, respectively. In the univariate analysis, the only maternal factor associated with any stage of ROP was spontaneous vaginal delivery (P = 0.049), but no maternal factor was an independent risk factor for type 1 ROP. Multivariate logistic regression analysis identified lower BW, lower gestational age and longer neonatal intensive care unit stay as independent risk factors for the development of ROP at any stage (P < 0.05). For Type 1 ROP, lower BW, and intraventricular hemorrhage were significant independent risk factors (P < 0.05). CONCLUSION: The only maternal risk factor related to ROP was spontaneous vaginal delivery, which increased the risk of any stage of ROP. The single most predictive risk factor for any stage of ROP and Type 1 ROP was low BW. These findings emphasize the role of the obstetrician in promoting health care and modifying maternal risk factors to prevent preterm births related to a low BW.
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Affiliation(s)
- Nooran Badeeb
- Department of Ophthalmology, University of Jeddah, Jeddah, Saudi Arabia
| | - Lina Raffa
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Huda AhmedHussain
- Department of Ophthalmology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Dania Bamefleh
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Enas Mgharbil
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sarah Alessa
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Aliaa Alamri
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed Albahiti
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
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Owen LA, Shirer K, Collazo SA, Szczotka K, Baker S, Wood B, Carroll L, Haaland B, Iwata T, Katikaneni LD, DeAngelis MM. The Serine Protease HTRA-1 Is a Biomarker for ROP and Mediates Retinal Neovascularization. Front Mol Neurosci 2020; 13:605918. [PMID: 33281553 PMCID: PMC7705345 DOI: 10.3389/fnmol.2020.605918] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 10/22/2020] [Indexed: 01/29/2023] Open
Abstract
Retinopathy of prematurity (ROP) is a blinding aberrancy of retinal vascular maturation in preterm infants. Despite delayed onset after preterm birth, representing a window for therapeutic intervention, we cannot prevent or cure ROP blindness. A natural form of ROP protection exists in the setting of early-onset maternal preeclampsia, though is not well characterized. As ischemia is a central feature in both ROP and preeclampsia, we hypothesized that angiogenesis mediators may underlie this protection. To test our hypothesis we analyzed peripheral blood expression of candidate proteins with suggested roles in preeclamptic and ROP pathophysiology and with a proposed angiogenesis function (HTRA-1, IGF-1, TGFβ-1, and VEGF-A). Analysis in a discovery cohort of 40 maternal-infant pairs found that elevated HTRA-1 (high-temperature requirement-A serine peptidase-1) was significantly associated with increased risk of ROP and the absence of preeclampsia, thus fitting a model of preeclampsia-mediated ROP protection. We validated these findings and further demonstrated a dose-response between systemic infant HTRA-1 expression and risk for ROP development in a larger and more diverse validation cohort consisting of preterm infants recruited from two institutions. Functional analysis in the oxygen-induced retinopathy (OIR) murine model of ROP supported our systemic human findings at the local tissue level, demonstrating that HtrA-1 expression is elevated in both the neurosensory retina and retinal pigment epithelium by RT-PCR in the ROP disease state. Finally, transgenic mice over-expressing HtrA-1 demonstrate greater ROP disease severity in this model. Thus, HTRA-1 may underlie ROP protection in preeclampsia and represent an avenue for disease prevention, which does not currently exist.
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Affiliation(s)
- Leah A Owen
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States
| | - Kinsey Shirer
- Department of Ophthalmology, Medical University of South Carolina, Charleston, SC, United States
| | - Samuel A Collazo
- School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Kathryn Szczotka
- Department of Obstetrics and Gynecology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States
| | - Shawna Baker
- Center for Clinical and Translational Science, University of Utah, Salt Lake City, UT, United States
| | - Blair Wood
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States
| | - Lara Carroll
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States
| | - Benjamin Haaland
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - Takeshi Iwata
- National Institute of Sensory Organs, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Lakshmi D Katikaneni
- Department of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC, United States
| | - Margaret M DeAngelis
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT, United States.,Department of Pharmacotherapy, The College of Pharmacy, University of Utah, Salt Lake City, UT, United States.,Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences State University of New York, Buffalo, NY, United States
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Zhu Z, Hua X, Yu Y, Zhu P, Hong K, Ke Y. Effect of red blood cell transfusion on the development of retinopathy of prematurity: A systematic review and meta-analysis. PLoS One 2020; 15:e0234266. [PMID: 32512582 PMCID: PMC7279893 DOI: 10.1371/journal.pone.0234266] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/21/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The effect of red blood cell (RBC) transfusion on retinopathy of prematurity (ROP) is difficult to establish, because ROP may also be influenced by other factors. Therefore, we carried out a systematic review and meta-analysis to explore the relationship between RBC transfusion and the development of ROP. METHODS The PubMed, Embase, Cochrane Library and Web of Science databases were searched from their inception to September 1, 2019. Observational studies that reported the relationship between RBC transfusion and ROP after adjusting for other potential risk factors were included. The combined result was analyzed by a random effect model. Heterogeneity and publication bias were tested, and sensitivity analysis was performed. RESULTS Of the 2628 identified records, 18 studies including 15072 preterm infants and 5620 cases of ROP were included. A random effect model was used and revealed that RBC transfusion was significantly associated with ROP (pooled OR = 1.50, 95% CI: 1.27-1.76), with moderate heterogeneity among the included studies (I2 = 44.2%). Subgroup analysis indicated that RBC transfusion was more closely related to ROP in the group with a gestational age (GA) ≤32 weeks (OR = 1.77, 95% CI: 1.29-2.43) but not in the groups with a GA ≤34 weeks (OR = 1.36, 95% CI: 0.85-2.18) or a GA <37 weeks (OR = 1.25, 95% CI: 0.86-1.82). No obvious publication bias was found based on the funnel plot and Egger's test. Removing any single study did not significantly alter the combined result in the sensitivity analysis. CONCLUSIONS Our study revealed that RBC transfusion is an independent risk factor for the development of ROP, especially in younger preterm infants. However, there seemed to be no evidence to support an effect of RBC transfusion on ROP in older groups. Further studies addressing this issue in older preterm neonates are warranted.
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Affiliation(s)
- Zhe Zhu
- Department of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Institute life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Xin Hua
- Ningbo Institute life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Department of Clinical Laboratory, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Yong Yu
- Department of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Institute life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Pan Zhu
- Neonatal intensive care unit, Ningbo Women & Children’s Hospital, Ningbo, Zhejiang, China
| | - Kairui Hong
- Department of Blood Transfusion, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
- Ningbo Institute life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Yefang Ke
- Department of Clinical Laboratory, Ningbo Women & Children’s Hospital, Ningbo, Zhejiang, China
- * E-mail:
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Carroll L, Owen LA. Current evidence and outcomes for retinopathy of prematurity prevention: insight into novel maternal and placental contributions. EXPLORATION OF MEDICINE 2020; 1:4-26. [PMID: 32342063 PMCID: PMC7185238 DOI: 10.37349/emed.2020.00002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 11/27/2019] [Indexed: 12/11/2022] Open
Abstract
Retinopathy of prematurity (ROP) is a blinding morbidity of preterm infants, which represents a significant clinical problem, accounting for up to 40% of all childhood blindness. ROP displays a range of severity, though even mild disease may result in life-long visual impairment. This is complicated by the fact that our current treatments have significant ocular and potentially systemic effects. Therefore, disease prevention is desperately needed to mitigate the life-long deleterious effects of ROP for preterm infants. Although ROP demonstrates a delayed onset of retinal disease following preterm birth, representing a potential window for prevention, we have been unable to sufficiently alter the natural disease course and meaningfully prevent ROP. Prevention therapeutics requires knowledge of early ROP molecular changes and risk, occurring prior to clinical retinal disease. While we still have an incomplete understanding of these disease mechanisms, emerging data integrating contributions of maternal/placental pathobiology with ROP are poised to inform novel approaches to prevention. Herein, we review the molecular basis for current prevention strategies and the clinical outcomes of these interventions. We also discuss how insights into early ROP pathophysiology may be gained by a better understanding of maternal and placental factors playing a role in preterm birth.
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Affiliation(s)
- Lara Carroll
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 4132, USA
| | - Leah A. Owen
- Department of Ophthalmology and Visual Sciences, University of Utah, Salt Lake City, UT 4132, USA
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12
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Prenatal and postnatal inflammation-related risk factors for retinopathy of prematurity. J Perinatol 2019; 39:964-973. [PMID: 30932029 PMCID: PMC6592770 DOI: 10.1038/s41372-019-0357-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/15/2019] [Accepted: 02/21/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the relationship between prenatal and postnatal inflammation-related risk factors and severe retinopathy of prematurity (ROP). STUDY DESIGN The study included infants born <30 weeks in California from 2007 to 2011. Multivariable log-binomial regression was used to assess the association between prenatal and postnatal inflammation-related exposures and severe ROP, defined as stage 3-5 or surgery for ROP. RESULTS Of 14,816 infants, 10.8% developed severe ROP. Though prenatal inflammation-related risk factors were initially associated with severe ROP, after accounting for the effect of these risk factors on gestational age at birth through mediation analysis, the association was non-significant (P = 0.6). Postnatal factors associated with severe ROP included prolonged oxygen exposure, sepsis, intraventricular hemorrhage, and necrotizing enterocolitis. CONCLUSION Postnatal inflammation-related factors were associated with severe ROP more strongly than prenatal factors. The association between prenatal inflammation-related factors and ROP was explained by earlier gestational age in infants exposed to prenatal inflammation.
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Snowden JM, Bovbjerg ML, Dissanayake M, Basso O. The curse of the perinatal epidemiologist: inferring causation amidst selection. CURR EPIDEMIOL REP 2018; 5:379-387. [PMID: 31086756 DOI: 10.1007/s40471-018-0172-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Purpose of review Human reproduction is a common process and one that unfolds over a relatively short time, but pregnancy and birth processes are challenging to study. Selection occurs at every step of this process (e.g., infertility, early pregnancy loss, and stillbirth), adding substantial bias to estimated exposure-outcome associations. Here we focus on selection in perinatal epidemiology, specifically, how it affects research question formulation, feasible study designs, and interpretation of results. Recent findings Approaches have recently been proposed to address selection issues in perinatal epidemiology. One such approach is the ongoing pregnancies denominator for gestation-stratified analyses of infant outcomes. Similarly, bias resulting from left truncation has recently been termed "live birth bias," and a proposed solution is to control for common causes of selection variables (e.g., fecundity, fetal loss) and birth outcomes. However, these approaches have theoretical shortcomings, conflicting with the foundational epidemiologic concept of populations at risk for a given outcome. Summary We engage with epidemiologic theory and employ thought experiments to demonstrate the problems of using denominators that include units not "at risk" of the outcome. Fundamental (and commonsense) concerns of outcome definition and analysis (e.g., ensuring that all study participants are at risk for the outcome) should take precedence in formulating questions and analysis approach, as should choosing questions that stakeholders care about. Selection and resulting biases in human reproductive processes complicate estimation of unbiased exposure- outcome associations, but we should not focus solely (or even mostly) on minimizing such biases.
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Affiliation(s)
- Jonathan M Snowden
- School of Public Health, Oregon Health and Science University-Portland State University, 3181 SW Sam Jackson Park Rd, Mail Code: CB-669, Portland, OR 97239-3098, USA
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code: L-466, Portland, OR 97239-3098, USA
| | - Marit L Bovbjerg
- College of Public Health and Human Sciences, Oregon State University, Milam Hall 103, Corvallis, OR 97331, USA
| | - Mekhala Dissanayake
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code: L-466, Portland, OR 97239-3098, USA
| | - Olga Basso
- Department of Obstetrics & Gynecology; Research Institute of the McGill University Health Centre
- Department of Epidemiology, Biostatistics, and Occupational Health McGill University, Purvis Hall, 1020 Pine Avenue West, Montreal QC H3A 1A2, Canada
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14
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Abstract
OBJECTIVE Using a simple simulation, we illustrate why associations estimated from studies restricted to preterm births cannot be interpreted causally. DESIGN, SETTING AND POPULATION Data simulation involving a hypothetical cohort of fetuses who may be healthy or have one or more of four pathological factors (termed A through D, increasing in severity) with known effects on gestational length and risk of mortality. We focus on babies born at ≤32 weeks of gestation. METHODS We visually represent the simulated population and compare the association between A (which may represent pre-eclampsia) and neonatal death. We then repeat the exercise with D (standing in for chorioamnionitis) as the exposure of interest. MAIN OUTCOME MEASURES Odds ratios of neonatal death in the simulated data. RESULTS In most weeks, and for both A and D, the calculated odds ratios are substantially biased and underestimate the true risk of neonatal death associated with each pathology. For example, factor A has a true causal odds ratio of 1.50, yet it appears protective among births ≤32 weeks (estimated crude odds ratio 0.39; gestational age-adjusted odds ratio 0.71). CONCLUSIONS Among very preterm births, virtually all babies are born with pathologies that increase the risk of adverse outcomes. Hence, babies exposed to one factor (e.g. pre-eclampsia) are compared with babies who have a mix of other pathologies. Such selection bias affects studies carried out among very preterm births (e.g. where pre-eclampsia appears to reduce risk of adverse neonatal outcomes). TWEETABLE ABSTRACT Selection bias affects studies of preterm births, complicating interpretation.
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Affiliation(s)
- J M Snowden
- School of Public Health, Oregon Health and Science University/Portland State University, Portland, OR, USA
- Department of Obstetrics & Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - O Basso
- Department of Obstetrics & Gynecology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, QC, Canada
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Kim SJ, Port AD, Swan R, Campbell JP, Chan RVP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv Ophthalmol 2018; 63:618-637. [PMID: 29679617 DOI: 10.1016/j.survophthal.2018.04.002] [Citation(s) in RCA: 272] [Impact Index Per Article: 45.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 01/09/2023]
Abstract
Retinopathy of prematurity (ROP) is a retinal vasoproliferative disease that affects premature infants. Despite improvements in neonatal care and management guidelines, ROP remains a leading cause of childhood blindness worldwide. Current screening guidelines are primarily based on two risk factors: birth weight and gestational age; however, many investigators have suggested other risk factors, including maternal factors, prenatal and perinatal factors, demographics, medical interventions, comorbidities of prematurity, nutrition, and genetic factors. We review the existing literature addressing various possible ROP risk factors. Although there have been contradictory reports, and the risk may vary between different populations, understanding ROP risk factors is essential to develop predictive models, to gain insights into pathophysiology of retinal vascular diseases and diseases of prematurity, and to determine future directions in management of and research in ROP.
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Affiliation(s)
- Sang Jin Kim
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA; Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Alexander D Port
- Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Ryan Swan
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA
| | - J Peter Campbell
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - R V Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, Illinois, USA; Center for Global Health, College of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Michael F Chiang
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA; Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, USA.
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16
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Yim CL, Tam M, Chan HL, Tang SM, Au SCL, Yip WWK, Ko STC, Rong SS, Chen LJ, Ng DSC, Yam JCS. Association of antenatal steroid and risk of retinopathy of prematurity: a systematic review and meta-analysis. Br J Ophthalmol 2018; 102:1336-1341. [DOI: 10.1136/bjophthalmol-2017-311576] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/12/2018] [Accepted: 03/18/2018] [Indexed: 02/05/2023]
Abstract
BackgroundRetinopathy of prematurity (ROP) is one of the leading causes of childhood blindness. Use of antenatal steroid can reduce neonatal morbidity and mortality in preterm births, but its effect on ROP remained controversial. We aim to determine the association between antenatal steroid and risk of ROP by a systematic review and meta-analysis.MethodsReported studies on the association between antenatal steroid and risk of ROP or severe ROP were identified from MEDLINE and Embase databases from their inception to November 2016. Outcome measures were ORs with 95% CIs. Extracted data were pooled using a random-effect model or fixed-effect model where appropriate. Heterogeneity was assessed, and sensitivity analysis was performed.ResultsA total of 434 relevant studies were identified, and 28 studies were eligible for the meta-analysis, involving 20 731 neonates with 4202 cases of ROP. Among the 28 studies included, 13 studies provided data evaluating the association between antenatal steroid use and severe ROP, involving 4999 neonates with 792 cases of severe ROP. Antenatal steroid administration was associated with a reduced risk of ROP development (ORunadjusted=0.82, 95% CI 0.68 to 0.98; ORadjusted=0.67, 95% CI 0.47 to 0.94) and progression to severe ROP (ORunadjusted=0.58, 95% CI 0.40 to 0.86).ConclusionAntenatal steroid administration is associated with a reduced risk of ROP development and progression to severe ROP. Our results strengthened the indications of antenatal steroid therapy to high-risk mothers giving preterm births, especially in low-income and middle-income countries where antenatal steroid are not yet widely used.
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Shulman JP, Weng C, Wilkes J, Greene T, Hartnett ME. Association of Maternal Preeclampsia With Infant Risk of Premature Birth and Retinopathy of Prematurity. JAMA Ophthalmol 2017; 135:947-953. [PMID: 28796851 DOI: 10.1001/jamaophthalmol.2017.2697] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Importance Studies report conflicting associations between preeclampsia and retinopathy of prematurity (ROP). This study provides explanations for the discrepancies to clarify the relationship between preeclampsia and ROP. Objective To evaluate the association of maternal preeclampsia and risk of ROP among infants in an unrestricted birth cohort and a restricted subcohort of preterm, very low birth weight (P-VLBW) infants. Design, Setting, and Participants A retrospective review of 290 992 live births within the Intermountain Healthcare System in Utah from January 1, 2001, through December 31, 2010, was performed. Generalized estimating equations for logistic regressions with covariate adjustment were applied to relate ROP to preeclampsia among the full cohort and in a subcohort of P-VLBW infants born at younger than 31 weeks' gestation and weighing less than 1500 g. Main Outcomes and Measures The occurrence of ROP was related to maternal preeclampsia in the full cohort and in a subcohort of P-VLBW infants. Results In the full cohort, 51% of the infants were male and the mean (SD) gestational age was 38.38 (1.87) weeks. In the P-VLBW cohort, 55% were male and the mean (SD) gestational age was 26.87 (2.40) weeks. In the full cohort, preeclampsia was associated with an increased risk of all ROP (adjusted odds ratio [aOR], 2.46; 95% CI, 2.17-2.79; P < .001), severe ROP (aOR, 5.21; 95% CI, 3.44-7.91; P < .001), infant death (aOR, 1.66; 95% CI, 1.16-2.38; P = .006), and giving birth to a P-VLBW infant (aOR, 7.74; 95% CI, 6.92-8.67; P < .001). In the P-VLBW subcohort, preeclampsia was inversely associated with the development of all ROP (aOR, 0.79; 95% CI, 0.68-0.92; P = .003), severe ROP (aOR, 0.62; 95% CI, 0.36-1.06; P = .08), and infant death (aOR, 0.19; 95% CI, 0.11-0.32; P < .001). Conclusions and Relevance Preeclampsia was associated with an increased risk of developing ROP among an unrestricted cohort but with a reduced risk of ROP among a restricted subcohort of P-VLBW infants. Although the conflicting associations in the full and P-VLBW cohorts may reflect true differences, the association of a reduced risk of ROP among the P-VLBW subcohort also may reflect biases from restricting the cohort to prematurity, because prematurity is an outcome of preeclampsia.
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Affiliation(s)
- Julia P Shulman
- New York Medical College, Valhalla.,Moran Eye Center, University of Utah, Salt Lake City
| | - Cindy Weng
- Moran Eye Center, University of Utah, Salt Lake City
| | - Jacob Wilkes
- Moran Eye Center, University of Utah, Salt Lake City
| | - Tom Greene
- Moran Eye Center, University of Utah, Salt Lake City
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Alshaikh B, Salman O, Soliman N, Ells A, Yusuf K. Pre-eclampsia and the risk of retinopathy of prematurity in preterm infants with birth weight <1500 g and/or <31 weeks' gestation. BMJ Open Ophthalmol 2017; 1:e000049. [PMID: 29354703 PMCID: PMC5721629 DOI: 10.1136/bmjophth-2016-000049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 01/31/2017] [Accepted: 03/09/2017] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the relationship between pre-eclampsia and development of retinopathy of prematurity (ROP) in infants with birth weight of <1500 g and/or gestation <31 weeks. Methods A retrospective cohort study comprising infants born to mothers with pre-eclampsia between January 2007 and June 2010 at a single tertiary care centre. Their ROP outcome was compared with infants born to the next two normotensive mothers with a ±1 week gestational age difference. Pearson χ2 test was used for categorical variables and Mann-Whitney U test was used for continuous variables. Multivariable regression was used to estimate the OR of ROP with prenatal pre-eclampsia exposure and adjust for confounders. Results Of the 97 infants in the pre-eclampsia group, 27 (27%) developed ROP and of the 185 infants in the normotensive group, 50 (27%) developed ROP. On multivariable regression modelling, pre-eclampsia was not a risk factor for the development of ROP (OR 1.4, 95% CI 0.46 to 4.1). Gestational age, intrauterine growth restriction and blood transfusion were significant risk factors for the development of ROP. Conclusions In our cohort, pre-eclampsia was not a significant risk factor for the development of ROP. Intrauterine growth restricted infants of pre-eclamptic and normotensive mothers were at higher risk of ROP.
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Affiliation(s)
- Belal Alshaikh
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Omar Salman
- University of Toronto at Scarborough, Toronto, Canada
| | - Nancy Soliman
- Department of Obstetrics and Gynecology, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Anna Ells
- Department of Ophthalmology, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Kamran Yusuf
- Department of Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Canada
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19
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Zhu T, Zhang L, Zhao F, Qu Y, Mu D. Association of maternal hypertensive disorders with retinopathy of prematurity: A systematic review and meta-analysis. PLoS One 2017; 12:e0175374. [PMID: 28388642 PMCID: PMC5384774 DOI: 10.1371/journal.pone.0175374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 03/26/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUD The role of maternal hypertensive disorders in pregnancy (HDP) in the development of retinopathy of prematurity (ROP) is unclear. METHODS Studies were retrieved through literature searches in PubMed, EMBASE, Web of Science and the Cochrane Library up to May 5, 2016 without language restrictions. Cohort or case-control studies that reported the association of maternal hypertensive disorders and retinopathy of prematurity were eligible. Either a fixed- or a random-effects model was used to calculate the overall combined risk estimates. RESULTS Thirteen cohort studies involving a total of 45082 individuals were included in the review. The pooled odds ratios of maternal hypertensive disorders in pregnancy for any stage and severe stages of ROP was 1.12 (95%CI: 0.90-1.40) and 0.80 (95%CI: 0.47-1.35), respectively. Sensitivity analyses confirmed that no single study qualitatively influenced the pooled OR. However, substantial heterogeneity and publication bias were observed in the meta-analysis. CONCLUSIONS Additional larger, prospective and well-adjusted studies are needed to determine the association between HDP and ROP, especially regarding the effects of different types of maternal hypertensive disorders in pregnancy on retinopathy of prematurity.
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Affiliation(s)
- TingTing Zhu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Li Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - FengYan Zhao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Yi Qu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, China
| | - Dezhi Mu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, China
- Department of Pediatrics and Neurology, University of California, San Francisco, San Francisco, California, United States of America
- * E-mail:
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20
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Protective effect of maternal uteroplacental insufficiency on oxygen-induced retinopathy in offspring: removing bias of premature birth. Sci Rep 2017; 7:42301. [PMID: 28195189 PMCID: PMC5307308 DOI: 10.1038/srep42301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/05/2017] [Indexed: 12/17/2022] Open
Abstract
To address the hypothesis that maternal uteroplacental insufficiency (UPI) increases severity of retinopathy of prematurity, we developed a composite rat model of UPI and oxygen-fluctuations and removed premature birth as a confounding factor. Timed-pregnant Sprague-Dawley dams underwent bilateral uterine artery ligation or anesthesia (control) at e19.5. Full-term pups developed in room air (RA) or an oxygen-induced retinopathy (OIR) model. Isolectin-stained retinal flat-mounts were analyzed for percent of areas of avascular/total retina (AVA) and of intravitreal neovascular/total retina (IVNV). Pup weights and serum and mRNA of liver and kidney VEGF, IGF-1, and erythropoietin (EPO) were determined. Multivariable mixed effects linear regressions and Pearson correlations were performed using STATA14. Postnatal growth restriction occurred in pups in UPI/RA, but not in UPI/OIR. Weight gain was similar between UPI/OIR and control/OIR pups. AVA was reduced and a trend toward reduced IVNV was seen in UPI/OIR compared to control/OIR. No difference in birth weights of UPI/OIR vs. control/OIR pups occurred. Serum and renal IGF-1 and EPO were significantly increased in UPI/OIR compared to control/OIR pups. In the absence of prematurity, UPI increased angiogenic factors in association with reduced OIR severity, suggesting that ischemia from UPI could yield protective angiogenic effects by offspring.
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Gemmell L, Martin L, Murphy KE, Modi N, Håkansson S, Reichman B, Lui K, Kusuda S, Sjörs G, Mirea L, Darlow BA, Mori R, Lee SK, Shah PS, Shah PS. Hypertensive disorders of pregnancy and outcomes of preterm infants of 24 to 28 weeks' gestation. J Perinatol 2016; 36:1067-1072. [PMID: 27583388 DOI: 10.1038/jp.2016.133] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/28/2016] [Accepted: 07/15/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To examine the relationship between hypertensive disorders of pregnancy (HDPs) and mortality and major morbidities in preterm neonates born at 24 to 28 weeks of gestation. STUDY DESIGN Using an international cohort, we retrospectively studied 27 846 preterm neonates born at 240 to 286 weeks of gestation during 2007 to 2010 from 6 national neonatal databases. The incidence of HDP was compared across countries, and multivariable logistic regression analyses were conducted to examine the association of HDP and neonatal outcomes including mortality to discharge, bronchopulmonary dysplasia, severe brain injury, necrotizing enterocolitis and treated retinopathy of prematurity. RESULTS The incidence of HDP in the entire cohort was 13% (range 11 to 16% across countries). HDP was associated with reduced odds of mortality (adjusted odds ratio (aOR) 0.77; 95% confidence interval (CI) 0.67 to 0.88), severe brain injury (aOR 0.74; 95% CI 0.62 to 0.89) and treated retinopathy (aOR 0.82; 95% CI 0.70 to 0.96), but increased odds of bronchopulmonary dysplasia (aOR 1.16; 95% CI 1.05 to 1.27). CONCLUSIONS In comparison with neonates born to mothers without HDP, neonates of HDP mothers had lower odds of mortality, severe brain injury and treated retinopathy, but higher odds of bronchopulmonary dysplasia. The impact of maternal HDP on newborn outcomes was inconsistent across outcomes and among countries; therefore, further international collaboration to standardize terminology, case definition and data capture is warranted.
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Affiliation(s)
- L Gemmell
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - L Martin
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - K E Murphy
- Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - N Modi
- UK Neonatal Collaborative, Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK
| | - S Håkansson
- Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden
| | - B Reichman
- Israel Neonatal Network, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Tel Hashomer, Israel
| | - K Lui
- Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, New South Wales, Australia
| | - S Kusuda
- Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Tokyo, Japan
| | - G Sjörs
- Swedish Neonatal Quality Register, Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden
| | - L Mirea
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - B A Darlow
- Australia and New Zealand Neonatal Network, Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - R Mori
- Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan
| | - S K Lee
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - P S Shah
- Canadian Neonatal Network, Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
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Chan PYL, Tang SM, Au SCL, Rong SS, Lau HHW, Ko STC, Ng DSC, Chen LJ, Yam JCS. Association of Gestational Hypertensive Disorders with Retinopathy of prematurity: A Systematic Review and Meta-analysis. Sci Rep 2016; 6:30732. [PMID: 27491726 PMCID: PMC4974497 DOI: 10.1038/srep30732] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 07/06/2016] [Indexed: 11/18/2022] Open
Abstract
The role of gestational hypertensive disorders, which includes both pre-eclampsia and gestational hypertension, in the development of retinopathy of prematurity (ROP) has been controversial. Therefore, this systematic review and meta-analysis is to evaluate the association between gestational hypertensive disoders and ROP. Eligible studies published up to June 5, 2016 were identified from MEDLINE and EMBASE that evaluated the association between the two conditions. Totally 1142 published records were retrieved for screening, 925 of them eligible for detailed evaluation. Finally 19 studies involving 45281 infants with 5388 cases of ROP met our criteria for meta-analysis. Gestational hypertensive disorders were not associated with ROP (unadjusted OR: 0.89; P = 0.38; adjusted OR: 1.35; P = 0.18). Subgroup analyses also revealed no significant association between ROP with pre-eclampsia (unadjusted OR: 0.85; P = 0.29; adjusted OR:1.29; P = 0.28) or with gestational hypertension (unadjusted OR: 1.10; P = 0.39; adjusted OR: 1.25; P = 0.60) separately. Sensitivity analysis indicated our results were robust. We concluded no significant association between gestational hypertensive disorders and ROP. More large scale well-conducted prospective cohorts on the topic are needed.
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Affiliation(s)
- Priscilla Y L Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Shu-Min Tang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Sunny C L Au
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong.,Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Shi-Song Rong
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Henry H W Lau
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Simon T C Ko
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
| | - Danny S C Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Li Jia Chen
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Jason C S Yam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
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23
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Yau GSK, Lee JWY, Tam VTY, Liu CCL, Yip S, Cheng E, Chu BCY, Yuen CYF. Incidence and Risk Factors of Retinopathy of Prematurity From 2 Neonatal Intensive Care Units in a Hong Kong Chinese Population. Asia Pac J Ophthalmol (Phila) 2016; 5:185-91. [PMID: 27183289 DOI: 10.1097/apo.0000000000000167] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To determine the incidence and risk factors of retinopathy of prematurity (ROP) in very low birth weight (VLBW) preterm Chinese infants. DESIGN Retrospective review. METHODS Medical records were reviewed for all neonates screened for ROP between January 2007 and December 2012 in Hong Kong. Screening was offered to VLBW (≤1500 g) and/or preterm (gestation, ≤32 weeks) neonates using the Royal College of Ophthalmologists ROP guideline and the International Classification of ROP by 3 pediatric ophthalmologists. Maternal and neonatal covariates were analyzed using univariate and multivariable logistic regression analyses for both ROP and type 1 ROP. RESULTS Of the 513 screened infants, the mean gestational age (GA) was 30.0 ± 2.5 weeks and the mean birth weight (BW) was 1232.6 ± 325.2 g. The incidence of ROP and type 1 ROP was 18.5% and 3.7%, respectively. In univariate analysis, a lighter BW, lower GA, blood transfusion, patent ductus arteriosus, nonsteroidal anti-inflammatory drug use, postnatal hypotension, inotropes usage, low Apgar scores, sepsis, mechanical ventilation, supplementary oxygen use, respiratory distress syndrome, anemia, surfactant use, and bronchopulmonary dysplasia were found to be associated with the development of both ROP and type 1 ROP (P < 0.05). In multivariable logistic regression analysis, BW, GA, and intraventricular hemorrhage were significant risk factors for ROP. Preeclampsia and eclampsia were the only protective factors for ROP development on multivariable logistic regression analysis (P = 0.02). CONCLUSIONS In VLBW preterm Chinese infants, lower GA, lighter BW, and intraventricular hemorrhage were significant risk factors for ROP, whereas preeclampsia and eclampsia were protective.
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Affiliation(s)
- Gordon S K Yau
- From the *Department of Ophthalmology, Caritas Medical Centre; †Department of Applied Mathematics, The Hong Kong Polytechnic University; and ‡Centre of Health Behaviours Research, The Chinese University of Hong Kong, Hong Kong
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Huang HC, Yang HI, Chou HC, Chen CY, Hsieh WS, Tsou KI, Tsao PN. Preeclampsia and Retinopathy of Prematurity in Very-Low-Birth-Weight Infants: A Population-Based Study. PLoS One 2015; 10:e0143248. [PMID: 26588850 PMCID: PMC4654513 DOI: 10.1371/journal.pone.0143248] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 11/02/2015] [Indexed: 11/18/2022] Open
Abstract
Preeclampsia and retinopathy of prematurity (ROP) are associated with impaired angiogenesis. Previous studies on the relationship between preeclampsia and ROP have produced conflicting results. The goal of this study was to evaluate the association between maternal preeclampsia and ROP using a large population-based cohort of very-low-birth-weight (VLBW) infants from 21 neonatal departments registered in the database of the Premature Baby Foundation of Taiwan. Multivariable logistic regression analysis was used to estimate the adjusted odds ratios (OR) and 95% confidence intervals (CI) for preeclampsia with reference to ROP and severe ROP. A total of 5,718 VLBW infants (844 cases with maternal preeclampsia) were included for analysis. The overall incidences of mild and severe ROP were 36.0% and 12.2%, respectively. Univariable analysis showed lower GA and lower birth weight, vaginal delivery, non-SGA, RDS, PDA, sepsis, transfusion, and absence of maternal preeclampsia to be associated with mild and severe ROP development. However, OR (95% CI) adjusted for the variables that were significant according to univariable analysis showed the risks of developing any-stage ROP and severe ROP for maternal preeclampsia to be 1.00 (0.84–1.20) and 0.89 (0.63–1.25), respectively. The results remained unchanged in stratified analyses according to SGA status. Our data showed that maternal preeclampsia was not associated with the subsequent development of any stage or severe ROP in VLBW infants.
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Affiliation(s)
- Hsin-Chung Huang
- Department of Pediatrics, Taipei City Hospital, Heping FuYou Branch, Taipei, Taiwan
| | - Hwai-I Yang
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Hung-Chieh Chou
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chien-Yi Chen
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wu-Shiun Hsieh
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Inn Tsou
- Department of Pediatrics, Catholic Tien Hospital, and College of Medicine, Fu Jen Catholic University, Taipei, Taiwan
| | - Po-Nien Tsao
- Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
- Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Dai AI, Demiryürek S, Aksoy SN, Perk P, Saygili O, Güngör K. Maternal Iron Deficiency Anemia as a Risk Factor for the Development of Retinopathy of Prematurity. Pediatr Neurol 2015; 53:146-50. [PMID: 26096619 DOI: 10.1016/j.pediatrneurol.2015.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 03/31/2015] [Accepted: 04/02/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Retinopathy of prematurity is a proliferative vascular disease affecting premature newborns and occurs during vessel development and maturation. The aim of this study was to evaluate the maternal iron deficiency anemia as possible risk factors associated with the development of retinopathy of prematurity among premature or very low birth weight infants. METHODS In this study, mothers of 254 infants with retinopathy of prematurity were analyzed retrospectively, and their laboratory results of medical records during pregnancy were reviewed for possible iron deficiency anemia. RESULTS In a cohort of 254 mothers of premature infants with retinopathy of prematurity, 187 (73.6%) had iron deficiency, while the remaining 67 (26.4%) mothers had no deficiency. Babies born to mothers with iron deficiency anemia with markedly decreased hemoglobin, hematocrit, mean corpuscular volume, serum iron, and ferritin levels were more likely to develop retinopathy of prematurity. CONCLUSIONS Our results are the first to suggest that maternal iron deficiency is a risk factor for the development of retinopathy of prematurity. Our data suggest that maternal iron supplementation therapy during pregnancy might lower the risk of retinopathy of prematurity.
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Affiliation(s)
- Alper I Dai
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
| | - Seniz Demiryürek
- Department of Physiology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Sefika Nur Aksoy
- Department of Biochemistry, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Peren Perk
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Oguzhan Saygili
- Department of Ophthalmology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Kivanc Güngör
- Department of Ophthalmology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
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Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth. Epidemiology 2015; 26:17-26. [PMID: 25437315 DOI: 10.1097/ede.0000000000000213] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Preeclampsia is characterized by alterations in angiogenic factors that may increase neonatal morbidity independent of preterm birth. METHODS We estimated the controlled direct effect of preeclampsia on neonatal outcomes independent of preterm birth among 200,103 normotensive and 10,507 preeclamptic singleton pregnancies in the Consortium on Safe Labor (2002-2008). Marginal structural models with stabilized inverse probability weights accounted for potential confounders in the pathway from preeclampsia to preterm birth to neonatal outcomes, including mediator-outcome confounders related to preeclampsia status, such as cesarean delivery. Controlled direct effects of preeclampsia on perinatal mortality, small for gestational age (SGA), neonatal intensive care unit (NICU) admission, respiratory distress syndrome, transient tachypnea of the newborn, anemia, apnea, asphyxia, peri- or intraventricular hemorrhage, and cardiomyopathy were estimated for the hypothesized intervention of term delivery for all infants. RESULTS When delivery was set at ≥37 weeks, preeclampsia increased the odds of perinatal mortality (odds ratio = 2.2 [95% confidence interval = 1.1-4.5], SGA = (1.9 [1.8-2.1]), NICU admission (1.9 [1.7-2.1]), respiratory distress syndrome (2.8 [2.0-3.7], transient tachypnea of the newborn (1.6 [1.3-1.9]), apnea (2.2 [1.6-3.1]), asphyxia (2.7 [1.5-4.9]), and peri- or intraventricular hemorrhage (3.2 [1.4-7.7]). No direct effect of preeclampsia at term was observed for anemia or cardiomyopathy. Our results appear robust in the presence of moderate confounding, and restriction to severe preeclampsia yielded similar findings. CONCLUSION Preeclampsia was directly associated with adverse neonatal outcomes beyond morbidity mediated by preterm birth. Although severe neonatal outcomes were less common at later gestational ages, marginal structural models suggested elevated neonatal risk due to preeclampsia even if it was possible to deliver all infants at term.
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Chen Y, Xun D, Wang YC, Wang B, Geng SH, Chen H, Li YT, Li XX. Incidence and risk factors of retinopathy of prematurity in two neonatal intensive care units in North and South China. Chin Med J (Engl) 2015; 128:914-8. [PMID: 25836612 PMCID: PMC4834008 DOI: 10.4103/0366-6999.154294] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND To investigate the incidence and risk factors of retinopathy of prematurity (ROP) in two Neonatal Intensive Care Units in North and South of China, respectively. METHODS We studied data concerning 472 infants with gestational age (GA) ≤ 34 weeks or birth weight (BW) ≤ 2000 g who were admitted to the Zhujiang Hospital of Southern Medical University and the Fourth Hospital of Shijiazhuang between January 1, 2011 and December 31, 2011. Clinical information about perinatal neonates was collected and was confirmed by reviewing medical charts. The incidence and severity of ROP were assessed in the screened population. Main outcome measures are the incidence and severity of ROP. The relationship of clinical risk factors and the development of ROP were analyzed. RESULTS The overall incidence of ROP was 12.7%, and the overall incidence of type 1 ROP was 2.3%; 9.4% of infants in Zhujiang Hospital had ROP compared to 15.0% infants in the Fourth Hospital of Shijiazhuang developed ROP, and the difference is statistically significant. ROP was significantly associated with GA (odds ratio [OR]: 0.77 [0.62-0.95], P = 0.015), BW (OR: 0.998 [0.996-0.999], P = 0.008), maternal supplemental oxygen administration before and during delivery (OR: 4.27 [1.21-15.10], P = 0.024) and preeclampsia (OR: 6.07 [1.73-21.36] P = 0.005). The risk factors for ROP are different in two hospitals. In Zhujiang Hospital, BW is the independent risk factors for ROP while GA, BW and preeclampsia in the Fourth Hospital in Shijiazhuang Conclusions: Retinopathy of prematurity incidence is different based on area. Incidence of ROP is still high in China. More efforts need to prevent ROP.
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Affiliation(s)
- Yi Chen
- Department of Ophthalmology, People's Hospital, Peking University, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing 100044, China
| | - Deng Xun
- Department of Ophthalmology, People's Hospital, Peking University, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing 100044, China
| | - Ya-Cong Wang
- Department of Ophthalmology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei 050011, China
| | - Bin Wang
- Department of Pediatric, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China
| | - Shao-Hui Geng
- Department of Ophthalmology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei 050011, China
| | - Hui Chen
- Department of Pediatric, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510282, China
| | - Yan-Tao Li
- Department of Ophthalmology, The Fourth Hospital of Shijiazhuang, Shijiazhuang, Hebei 050011, China
| | - Xiao-Xin Li
- Department of Ophthalmology, People's Hospital, Peking University, Key Laboratory of Vision Loss and Restoration, Ministry of Education, Beijing 100044, China
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Thomas K, Shah PS, Canning R, Harrison A, Lee SK, Dow KE. Retinopathy of prematurity: Risk factors and variability in Canadian neonatal intensive care units. J Neonatal Perinatal Med 2015; 8:207-214. [PMID: 26485554 DOI: 10.3233/npm-15814128] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To identify predictors of severe retinopathy of prematurity (ROP) in a large population-based cohort and to examine risk-adjusted variations across units. STUDY DESIGN Retrospective analysis of Canadian Neonatal Network data on neonates with birth weight <1500 g who were screened for ROP between 2003 and 2010. Characteristics of infants with and without ROP were compared and a risk-adjusted model for severe ROP was developed. Rates of severe ROP were compared between sites. RESULTS 1163 of 9187 (12.7%) infants developed severe ROP. Lower gestational age, male sex, small for gestational age, patent ductus arteriosus, late onset sepsis, more than two blood transfusions, inotrope use, and outborn status were associated with an increased risk of severe ROP. Severe ROP rates varied significantly between units. CONCLUSION Younger, smaller and sicker male infants had higher adjusted risks of severe ROP and rates varied significantly among sites.
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Affiliation(s)
- K Thomas
- Department of Pediatrics, Kingston General Hospital, Kingston, Ontario, Canada
| | - P S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - R Canning
- Department of Pediatrics, Moncton Hospital, Moncton, New Brunswick, Canada
| | - A Harrison
- Department of Pediatrics, Victoria General Hospital, Victoria, British Columbia, Canada
| | - S K Lee
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - K E Dow
- Department of Pediatrics, Kingston General Hospital, Kingston, Ontario, Canada
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Auger N, Gilbert NL, Naimi AI, Kaufman JS. Fetuses-at-risk, to avoid paradoxical associations at early gestational ages: extension to preterm infant mortality. Int J Epidemiol 2014; 43:1154-62. [PMID: 24513685 PMCID: PMC4258766 DOI: 10.1093/ije/dyu011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Fetuses-at-risk denominators are commonly used in research on preterm stillbirth, but applications to postnatal outcomes such as preterm infant mortality are controversial. We evaluated whether biased associations between maternal risk factors and preterm infant mortality caused by stratification by preterm birth could be avoided using fetuses-at-risk risk ratios. METHODS Data included 3 277 570 births drawn from the linked live birth-death file for Canada from 1990 through 2005. We used maternal age as the risk factor, and estimated the association with stillbirth, early neonatal, late neonatal and postneonatal mortality by gestational interval (22-24, 25-27, 28-31, 32-36, ≥37 weeks). Models were run using (i) log-binomial regression stratified by preterm gestational age, and (ii) unstratified log-binomial regression using fetuses-at-risk denominators. RESULTS Extremes of maternal age were associated with higher mortality among term births. Among preterm births, the stratified model suggested a protective, null or attenuated association of extremes of maternal age with stillbirth, early, late and post neonatal mortality. The unstratified fetuses-at-risk model, however, resulted in the expected higher risk of mortality at extremes of maternal age for all outcomes. CONCLUSIONS Fetuses-at-risk regression can avoid paradoxical associations between maternal exposures and mortality of infants born early in gestation, caused by preterm birth stratification bias. The fetuses-at-risk approach can be extended through the first year of life, or potentially beyond, depending on the outcome and presence of unmeasured confounders associated with preterm birth.
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Affiliation(s)
- Nathalie Auger
- Institut national de sante publique du Québec, Montréal, Québec, Canada, Research Centre of the University of Montréal Hospital Centre, Montréal, Québec, Canada, Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada, Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, CanadaInstitut national de sante publique du Québec, Montréal, Québec, Canada, Research Centre of the University of Montréal Hospital Centre, Montréal, Québec, Canada, Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada, Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, CanadaInstitut national de sante publique du Québec, Montréal, Québec, Canada, Research Centre of the University of Montréal Hospital Centre, Montréal, Québec, Canada, Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada, Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Nicolas L Gilbert
- Institut national de sante publique du Québec, Montréal, Québec, Canada, Research Centre of the University of Montréal Hospital Centre, Montréal, Québec, Canada, Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada, Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, CanadaInstitut national de sante publique du Québec, Montréal, Québec, Canada, Research Centre of the University of Montréal Hospital Centre, Montréal, Québec, Canada, Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada, Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Ashley I Naimi
- Institut national de sante publique du Québec, Montréal, Québec, Canada, Research Centre of the University of Montréal Hospital Centre, Montréal, Québec, Canada, Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada, Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Jay S Kaufman
- Institut national de sante publique du Québec, Montréal, Québec, Canada, Research Centre of the University of Montréal Hospital Centre, Montréal, Québec, Canada, Department of Social and Preventive Medicine, University of Montréal, Montréal, Québec, Canada, Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada and Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
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Gagliardi L, Rusconi F, Bellù R, Zanini R. Association of maternal hypertension and chorioamnionitis with preterm outcomes. Pediatrics 2014; 134:e154-61. [PMID: 24913788 DOI: 10.1542/peds.2013-3898] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We compared the relative effect of hypertensive disorders of pregnancy and chorioamnionitis on adverse neonatal outcomes in very preterm neonates, and studied whether gestational age (GA) modulates these effects. METHODS A cohort of neonates 23 to 30 weeks' GA, born in 2008 to 2011 in 82 hospitals adhering to the Italian Neonatal Network, was analyzed. Infants born from mothers who had hypertensive disorders (N = 2096) were compared with those born after chorioamnionitis (N = 1510). Statistical analysis employed logistic models, adjusting for GA, hospital, and potential confounders. RESULTS Overall mortality was higher after hypertension than after chorioamnionitis (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.08-1.80), but this relationship changed across GA weeks; the OR for hypertension was highest at low GA, whereas from 28 weeks' GA onward, mortality was higher for chorioamnionitis. For other outcomes, the relative risks were constant across GA; infants born after hypertension had an increased risk for bronchopulmonary dysplasia (OR, 2.20; 95% CI, 1.68-2.88) and severe retinopathy of prematurity (OR, 1.48; 95% CI, 1.02-2.15), whereas there was a lower risk for early-onset sepsis (OR, 0.25; 95% CI, 0.19-0.34), severe intraventricular hemorrhage (OR, 0.65; 95% CI, 0.48-0.88), periventricular leukomalacia (OR, 0.70; 95% CI, 0.48-1.01), and surgical necrotizing enterocolitis or gastrointestinal perforation (OR, 0.47; 95% CI, 0.31-0.72). CONCLUSIONS Mortality and other adverse outcomes in very preterm infants depend on antecedents of preterm birth. Hypertension and chorioamnionitis are associated with different patterns of outcomes; for mortality, the effect changes across GA weeks.
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Affiliation(s)
- Luigi Gagliardi
- Department of Woman and Child Health, Ospedale Versilia, Viareggio, Italy;
| | - Franca Rusconi
- Unit of Epidemiology, A Meyer Children's University Hospital, Florence, Italy; and
| | - Roberto Bellù
- Neonatal ICU, Ospedale Alessandro Manzoni, Lecco, Italy
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Abstract
OBJECTIVE The relationship between gestational hypertension, preeclampsia, and the risk of retinopathy of prematurity (ROP) remains unclear. Thus, we used a large cohort database to study the influence of maternal gestational hypertension and preeclampsia on the occurrence of ROP in preterm infants. METHODS We used data from a previous retrospective cohort study that includes 25,473 eligible preterm neonates. We examined the association between gestational hypertension, preeclampsia, and ROP while controlling for potential confounders by multiple logistic regression analysis. RESULTS Of the 8758 early preterm infants (gestational age <34 weeks), 1024 (11.69%) had ROP, while of the 16,715 late preterm infants, only 29 (0.17%) had ROP. After adjusting for confounders, preeclampsia was associated with a significantly reduced risk of ROP (adjusted odds ratio [aOR], 0.65; 95% confidence interval [CI], 0.49-0.86 for early preterm birth; aOR, 0.10; 95% CI, 0.01-0.93 for late preterm birth; aOR, 0.66; 95% CI, 0.50-0.87 for all preterm births). Gestational hypertension was not significantly associated with ROP at early or late preterm births. CONCLUSIONS Preeclampsia, but not gestational hypertension, was associated with a reduced risk of ROP in preterm births.
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Affiliation(s)
- Xiao Dan Yu
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - D. Ware Branch
- Intermountain Healthcare and the University of Utah, Salt Lake City, Utah; and
| | - S. Ananth Karumanchi
- Howard Hughes Medical Institute and Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xin Hua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Abstract
The major known risk factors for retinopathy of prematurity (ROP) are extremely low gestational age, exposure to high levels of oxygen early after birth (phase I) and relatively lower oxygen levels later (phase II). In this review, we summarize recent data suggesting that exposure to perinatal infection/inflammation is associated with an increased risk for ROP. Part of this effect might be due to direct exposure of the developing retina to circulating products of infection and/or inflammation. Another potential mechanism that deserves exploration is that inflammation and/or oxidative stress can modify the known increased risk of oxygen-associated ROP. Taken together, accumulating evidence suggests that prenatal, perinatal, and postnatal systemic inflammation contribute to a 'pre-phase', sensitizing the pre-ROP retina for subsequent insults, setting the stage for what are now called phase I and phase II of ROP pathogenesis. Strategies targeting inflammatory responses might help reduce the risk for ROP in extremely low gestational age newborns.
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Educational inequalities in preterm and term small-for-gestational-age birth over time. Ann Epidemiol 2012; 22:160-7. [PMID: 22285866 DOI: 10.1016/j.annepidem.2012.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 01/10/2012] [Accepted: 01/12/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE Time trends in educational inequalities in small-for-gestational-age (SGA) birth are important to evaluate for policy, especially at preterm gestational ages when morbidity and mortality are typically greater. We evaluated educational inequalities in preterm and term SGA birth over time, accounting for potential bias at preterm gestational ages. METHODS Data included 2,204,056 singleton live births from 25 to 43 gestational weeks, 1981 to 2007. We estimated prevalence ratios (PR) and percent prevalence differences (PPD) of preterm and term SGA birth for a continuous education score, accounting for maternal characteristics. Sensitivity analyses included correction for misclassification of preterm SGA status, and use of fetuses-at-risk denominators in regression models. RESULTS Although prevalence of SGA birth decreased over time, relative educational inequalities (PRs) persisted for preterm and term cases. PPDs decreased slightly, but more for term than preterm SGA birth. Sensitivity analyses indicated that PRs for education were stronger for preterm than term SGA birth. PPDs were larger for term SGA birth in the first period, but greater for preterm SGA birth in the last period. CONCLUSIONS Relative educational inequalities in SGA birth persisted over time. The difference in prevalence between the least and most educated mothers is currently greater for preterm than for term SGA birth.
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Chemokines plasma levels in preterm newborns of preeclamptic mothers. Cytokine 2011; 56:515-9. [PMID: 21820916 DOI: 10.1016/j.cyto.2011.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Revised: 06/24/2011] [Accepted: 07/11/2011] [Indexed: 11/23/2022]
Abstract
Information on leukocyte activation in newborn infants of preeclamptic mothers is scarce. IL-8 and GRO-α are the main pro-inflammatory cytokines involved in leukocyte activation. The objective was to evaluate IL-8 and GRO-α plasma levels in preterm newborns infants of preeclamptic mothers. Newborns with gestational age<36 weeks and birth weight<2000 g were included and divided: non-preeclamptic (n=64) and preeclamptic groups (n=55). Exclusion criteria were major congenital malformations, inborn errors of metabolism or chromosomal anomalies, congenital infections, death in delivery room, and maternal chronic hypertension without preeclampsia. IL-8 and GRO-α were measured by enzyme immunoassay in the first 48 h. Groups were similar in birth weight, gestational age, Apgar scores at 5 min, sepsis, RDS, mechanical ventilation, TPN, NEC, intraventricular hemorrhage and death. The preeclamptic group had more neutropenia, SGA, cesarean section, and less rupture of membranes>18 h. IL-8 was higher in the non-preeclamptic [157.1 pg/mL (86.4-261.3) and 26.54 pg/mL (3.6-87.2) p<0.001]. GRO-α levels were similar in both groups [229.5 pg/mL (116.6-321.3) and 185.5 pg/mL (63.9-306.7) p=0.236]. After multiple regression analysis only absence of preeclampsia was associated with high IL-8 levels. Our data suggest that leukocyte activation may be impaired in infants of preeclamptic mothers.
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