Relationship between Hyperglycemia and Retinopathy of Prematurity in Very Low Birth Weight Infants

Retinopathy of prematurity (ROP) is a multifactorial vasoproliferative retinal disorder that increases in incidence with decreasing gestational age. Recently, an association between hyperglycemia and severe ROP was found in extremely low birth weight infants (ELBWI). The purpose of this study was to evaluate the possible relation between hyperglycemia and ROP at any stage in very low birth weight infants (VLBWI). We analyzed the data of 201 VLBWI. The incidence of ROP and hyperglycemia was detected and the χ2 test was applied to investigate the association between the two variables. The Clinical Risk Index for Babies (CRIB) score was attributed as a marker of illness severity. The incidence of ROP and hyperglycemia in VLBWI was 35.3 and 19.4%, respectively. ROP developed more frequently in hyperglycemic infants (p < 0.001). The gestational age, birth weight, and Apgar scores were significantly lower, the CRIB score was higher in ROP patients. In hyperglycemic ROP patients the CRIB score was significantly higher compared to euglycemic ROP patients (mean (SD) 8.1 (4.2) vs. 5.5 (3.3); p < 0.01). A logistic regression model revealed that gestational age (OR 0.59; 95% CI 0.46–0.76; p < 0.001) and hyperglycemia (OR 3.15; 95% CI 1.12–8.84; p < 0.05) are independent risk factors in ROP development. When ELBWI were analyzed separately, gestational age (OR 0.38; 95% CI 0.20–0.72; p < 0.01) and CRIB score (OR 1.58; 95% CI 1.02–2.45; p < 0.05) were found as significant contributors. Further studies are needed to elucidate the pathophysiological role of hyperglycemia in the development of vasoproliferative retinal disorder.

[1]  the Swiss Neonatal Network.  The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units , 1993, The Lancet.

[2]  J. Flynn,et al.  Supplemental Therapeutic Oxygen for Prethreshold Retinopathy Of Prematurity (STOP-ROP), a randomized, controlled trial. I: primary outcomes. , 2000, Pediatrics.

[3]  L. Aiello.  Vascular endothelial growth factor and the eye: biochemical mechanisms of action and implications for novel therapies. , 1998, Ophthalmic research.

[4]  I. Casteels,et al.  Retinopathy of Prematurity: Any Difference in Risk Factors between a High and Low Risk Population? , 2003, European journal of ophthalmology.

[5]  B. Vásárhelyi,et al.  Association of Genetic Polymorphisms of Vascular Endothelial Growth Factor and Risk for Proliferative Retinopathy of Prematurity , 2005, Pediatric Research.

[6]  Christoph U. Lehmann,et al.  Hyperglycemia and Retinopathy of Prematurity in Very Low Birth Weight Infants , 2003, Journal of Perinatology.

[7]  J. Magny,et al.  Both relative insulin resistance and defective islet beta-cell processing of proinsulin are responsible for transient hyperglycemia in extremely preterm infants. , 2004, Pediatrics.

[8]  A. Vianello,et al.  Is the CRIB Score (Clinical Risk Index for Babies) a Valid Tool in Predicting Neurodevelopmental Outcome inExtremely Low Birth Wei ght Infants? , 1999, Neonatology.

[9]  Lois E. H. Smith,et al.  Postnatal serum insulin-like growth factor I deficiency is associated with retinopathy of prematurity and other complications of premature birth. , 2003, Pediatrics.

[10]  K. Patel,et al.  Sudden Infant Death Syndrome in Child Care Settings , 2000, Pediatrics.

[11]  C. Bührer,et al.  The CRIB (Clinical Risk Index for Babies) score and neurodevelopmental impairment at one year corrected age in very low birth weight infants , 2000, Intensive Care Medicine.