PEDIATRICS Vol. 115 No. 4 April 2005, pp. 990-996 (doi:10.1542/peds.2004-1309)
Prenatal Risk Factors for Severe Retinopathy of Prematurity Among Very Preterm Infants of the Australian and New Zealand Neonatal Network
* Department of Paediatrics, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand
Centre for Perinatal Health Services Research
School of Public Health
|| Department of Newborn Care, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
Objective. To identify prenatal and perinatal risk factors for clinically severe (stage 3 or 4) retinopathy of prematurity (ROP).
Methods. Data were collected prospectively as part of the ongoing Australian and New Zealand Neonatal Network audit of high-risk infants (birth weight of <1500 g or gestational age [GA] of <32 weeks) admitted to a level III neonatal unit in Australia or New Zealand. Prenatal and perinatal factors to 1 minute of age were examined for the subset of infants with GA of <29 weeks who survived to 36 weeks’ postmenstrual age and were examined for ROP (n = 2105). The factors significantly associated with stage 3 or 4 ROP were entered into a multivariate logistic regression model.
Results. Two-hundred three infants (9.6%) had stage 3 or more ROP. Prematurity was the dominant risk factor, with infants with GA of <25 weeks having 20 times greater odds of severe ROP than infants with GA of 28 weeks. Birth weight for GA also had a "dose-response" effect; the more growth-restricted infants had greater risk, with infants below the 3rd percentile of weight for GA having 4 times greater odds of severe ROP than those between the 25th and 75th percentiles. Male gender was also a significant risk factor (odds ratio: 1.73; 95% confidence interval: 1.25–2.40).
Conclusions. These data, for a large, essentially population-based cohort, suggest that factors related to the degree of immaturity, intrauterine growth restriction, and male gender contribute to severe ROP.
Key Words: infant • premature • retinopathy of prematurity • gestational age • population based • small for gestational age
Abbreviations: ROP, retinopathy of prematurity • SGA, small for gestational age • GA, gestational age • ANZNN, Australian and New Zealand Neonatal Network • ROC, receiver operating characteristic • OR, odds ratio • CI, confidence interval • IQR, interquartile range • IGF-1, insulin-like growth factor-1
Accepted Aug 23, 2004.
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