Retinopathy of prematurity (ROP) still has important sequelae, often associated with other complications. We studied the association between severe ROP needing surgery and brain and lung damage, namely ultrasound-defined cystic periventricular leucomalacia (PVL), intraventricular haemorrhage (IVH) and bronchopulmonary dysplasia (BPD) (oxygen need at 36 weeks) in infants less than 1500 g and less than 30 weeks gestation.
We analysed two large recent Italian cohorts: the Network Neonatale Lombardo and the Italian Neonatal Network (Italian branch of the Vermont–Oxford Network).
Infants less than 23 or more than 29 weeks gestation dying in the delivery room with malformations were excluded.
Results Mean birthweight of the sample was 962 g; mean gestation 27.3 weeks. 96 infants (7.4%) had ROP surgery; of these, only 22 after 26 weeks gestation and only nine with birthweight greater than 1000 g. 21.3% had IVH grades 1–2; 6.5% IVH grades 3–4; 9.5% PVL and 24.8% BPD. After adjusting (conditional logistic regression) for gestation, significant risk factors for ROP surgery were: late-onset sepsis (odds ratio (OR) 2.30); cystic PVL (OR 3.54); BPD (OR 1.93), all p<0.01. IVH was not associated: OR 0.96 for IVH grades 1–2 and OR 1.06 for IVH grades 3–4 (p>0.85). Sex, antenatal steroids, mode of delivery, Apgar scores, multiple gestation, location of birth, birthweight and Z-score, ventilation, pneumothorax, patent ductus arteriosus, surfactant, early-onset sepsis were not significant.
Conclusions PVL, BPD and late-onset sepsis are associated with severe ROP; this points to shared pathways (inflammation?) causing multiple outcomes. IVH was not associated with severe ROP; however, as infants with severe IVH are more likely to die early, before developing ROP, this may reflect selective survival.
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