Tags

Type your tag names separated by a space and hit enter

The relationship of the subtypes of preterm birth with retinopathy of prematurity.
Am J Obstet Gynecol. 2017 09; 217(3):354.e1-354.e8.AJ

Abstract

BACKGROUND

Retinopathy of prematurity is an adverse outcome of preterm birth and is a leading cause of childhood blindness. The relationship between the subtypes of preterm birth with retinopathy of prematurity is understudied.

OBJECTIVE

To investigate whether there is a difference in the incidence of type 1 or type 2 retinopathy of prematurity in infants with preterm birth resulting from spontaneous preterm labor, a medical indication of preterm birth, or preterm premature rupture of the membranes.

STUDY DESIGN

A retrospective cohort study was conducted of 827 infants screened for retinopathy of prematurity who were delivered at a single tertiary care center in Colorado. All infants fulfilled the American Academy of Pediatrics 2013 screening criteria for retinopathy of prematurity defined as "infants with a birth weight of ≤1500 g or gestational age of 30 weeks or less (as defined by the attending neonatologist) and selected infants with a birth weight between 1500 and 2000 g or gestational age of >30 weeks with an unstable clinical course, including those requiring cardiorespiratory support and who are believed by their attending pediatrician or neonatologist to be at high risk for retinopathy of prematurity." Two independent reviewers masked to retinopathy of prematurity outcomes determined whether preterm birth resulted from spontaneous preterm labor, medical indication of preterm birth, or preterm premature rupture of the membranes. Discrepancies were resolved by a third reviewer. Data were analyzed with univariate and multivariable logistic regression.

RESULTS

In our cohort, the frequency of preterm birth resulting from spontaneous preterm labor, medical indication of preterm birth, or preterm premature rupture of the membranes was 34%, 40%, and 26%, respectively. The mean gestational age (weeks, days) ± SD (range) in the cohort and across the preterm birth subtypes was as follows: entire cohort, 28 weeks, 6 days ± 2 weeks, 3 days (23 weeks, 3 days - 36 weeks, 4 days); spontaneous preterm labor, 28 weeks 1 day ± 2 weeks, 3 days (23 weeks, 3 days - 33 weeks, 4 days); medical indication of preterm birth, 29 weeks, 1 day ± 2 weeks, 2 days (24-36 weeks, 4 days); preterm premature rupture of the membranes, 28 weeks, 4 days ± 2 weeks, 1 day (24-33 weeks, 1 day). Among infants with type 1, type 2, or no retinopathy of prematurity, the incidence of type 1 or type 2 retinopathy of prematurity in births from spontaneous preterm labor, medical indication of preterm birth, and preterm premature rupture of the membranes was 37 of 218 (17%), 27 of 272 (10%), and 10 of 164 (6%), respectively. Adjusted for gestational age, birth weight, and multiparity and compared with the preterm premature rupture of the membranes group, the odds ratios of spontaneous preterm labor and medical indication of preterm birth for type 1 or type 2 retinopathy of prematurity were 6.1 (95% confidence interval, 1.8 to 20, P = .003) and 5.5 (95% confidence interval, 1.4 to 21, P = .01), respectively. Among neonates born after preterm premature rupture of the membranes, the probability of developing type 1 or type 2 retinopathy of prematurity was greatest in infants with rupture of membrane duration of up to 24 hours. After 24 hours, the probability of developing type 1 or type 2 retinopathy of prematurity declined. The odds of developing type 1 or type 2 retinopathy of prematurity was 9.0 (95% confidence interval 2.3 to 34, P = .002) in infants who had preterm premature rupture of the membranes ≤ 24 hours compared with infants who had preterm premature rupture of the membranes > 24 hours.

CONCLUSION

Type 1 or type 2 retinopathy of prematurity are adverse ocular outcomes linked with not only lower gestational age and birth weight at delivery but also with events in the intrauterine environment that trigger a preterm birth. The reduced incidence of type 1 or type 2 retinopathy of prematurity in the preterm premature rupture of the membranes group compared with other causes of preterm birth may be related to the perinatal therapies associated with preterm premature rupture of the membranes (such as corticosteroids, antibiotics, maternal-fetal surveillance), which may have an inhibitory effect on the development of retinopathy of prematurity. We suggest that the physiologic events that predispose infants to type 1 or type 2 retinopathy of prematurity begin before delivery.

Authors+Show Affiliations

Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO. Electronic address: Anne.Lynch@ucdenver.edu.Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO.Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO.Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO.Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO.Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO.Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO.Department of Obstetrics and Gynecology, Stanford University, Palo Alto, CA.Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28545834

Citation

Lynch, Anne M., et al. "The Relationship of the Subtypes of Preterm Birth With Retinopathy of Prematurity." American Journal of Obstetrics and Gynecology, vol. 217, no. 3, 2017, pp. 354.e1-354.e8.
Lynch AM, Wagner BD, Hodges JK, et al. The relationship of the subtypes of preterm birth with retinopathy of prematurity. Am J Obstet Gynecol. 2017;217(3):354.e1-354.e8.
Lynch, A. M., Wagner, B. D., Hodges, J. K., Thevarajah, T. S., McCourt, E. A., Cerda, A. M., Mandava, N., Gibbs, R. S., & Palestine, A. G. (2017). The relationship of the subtypes of preterm birth with retinopathy of prematurity. American Journal of Obstetrics and Gynecology, 217(3), e1-e8. https://doi.org/10.1016/j.ajog.2017.05.029
Lynch AM, et al. The Relationship of the Subtypes of Preterm Birth With Retinopathy of Prematurity. Am J Obstet Gynecol. 2017;217(3):354.e1-354.e8. PubMed PMID: 28545834.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The relationship of the subtypes of preterm birth with retinopathy of prematurity. AU - Lynch,Anne M, AU - Wagner,Brandie D, AU - Hodges,Jennifer K, AU - Thevarajah,Tamara S, AU - McCourt,Emily A, AU - Cerda,Ashlee M, AU - Mandava,Naresh, AU - Gibbs,Ronald S, AU - Palestine,Alan G, Y1 - 2017/05/22/ PY - 2017/01/30/received PY - 2017/04/19/revised PY - 2017/05/12/accepted PY - 2017/5/27/pubmed PY - 2017/9/19/medline PY - 2017/5/27/entrez KW - medically indicated preterm birth KW - preterm premature rupture of the membranes KW - retinopathy of prematurity KW - spontaneous preterm labor KW - subtypes of preterm birth SP - 354.e1 EP - 354.e8 JF - American journal of obstetrics and gynecology JO - Am J Obstet Gynecol VL - 217 IS - 3 N2 - BACKGROUND: Retinopathy of prematurity is an adverse outcome of preterm birth and is a leading cause of childhood blindness. The relationship between the subtypes of preterm birth with retinopathy of prematurity is understudied. OBJECTIVE: To investigate whether there is a difference in the incidence of type 1 or type 2 retinopathy of prematurity in infants with preterm birth resulting from spontaneous preterm labor, a medical indication of preterm birth, or preterm premature rupture of the membranes. STUDY DESIGN: A retrospective cohort study was conducted of 827 infants screened for retinopathy of prematurity who were delivered at a single tertiary care center in Colorado. All infants fulfilled the American Academy of Pediatrics 2013 screening criteria for retinopathy of prematurity defined as "infants with a birth weight of ≤1500 g or gestational age of 30 weeks or less (as defined by the attending neonatologist) and selected infants with a birth weight between 1500 and 2000 g or gestational age of >30 weeks with an unstable clinical course, including those requiring cardiorespiratory support and who are believed by their attending pediatrician or neonatologist to be at high risk for retinopathy of prematurity." Two independent reviewers masked to retinopathy of prematurity outcomes determined whether preterm birth resulted from spontaneous preterm labor, medical indication of preterm birth, or preterm premature rupture of the membranes. Discrepancies were resolved by a third reviewer. Data were analyzed with univariate and multivariable logistic regression. RESULTS: In our cohort, the frequency of preterm birth resulting from spontaneous preterm labor, medical indication of preterm birth, or preterm premature rupture of the membranes was 34%, 40%, and 26%, respectively. The mean gestational age (weeks, days) ± SD (range) in the cohort and across the preterm birth subtypes was as follows: entire cohort, 28 weeks, 6 days ± 2 weeks, 3 days (23 weeks, 3 days - 36 weeks, 4 days); spontaneous preterm labor, 28 weeks 1 day ± 2 weeks, 3 days (23 weeks, 3 days - 33 weeks, 4 days); medical indication of preterm birth, 29 weeks, 1 day ± 2 weeks, 2 days (24-36 weeks, 4 days); preterm premature rupture of the membranes, 28 weeks, 4 days ± 2 weeks, 1 day (24-33 weeks, 1 day). Among infants with type 1, type 2, or no retinopathy of prematurity, the incidence of type 1 or type 2 retinopathy of prematurity in births from spontaneous preterm labor, medical indication of preterm birth, and preterm premature rupture of the membranes was 37 of 218 (17%), 27 of 272 (10%), and 10 of 164 (6%), respectively. Adjusted for gestational age, birth weight, and multiparity and compared with the preterm premature rupture of the membranes group, the odds ratios of spontaneous preterm labor and medical indication of preterm birth for type 1 or type 2 retinopathy of prematurity were 6.1 (95% confidence interval, 1.8 to 20, P = .003) and 5.5 (95% confidence interval, 1.4 to 21, P = .01), respectively. Among neonates born after preterm premature rupture of the membranes, the probability of developing type 1 or type 2 retinopathy of prematurity was greatest in infants with rupture of membrane duration of up to 24 hours. After 24 hours, the probability of developing type 1 or type 2 retinopathy of prematurity declined. The odds of developing type 1 or type 2 retinopathy of prematurity was 9.0 (95% confidence interval 2.3 to 34, P = .002) in infants who had preterm premature rupture of the membranes ≤ 24 hours compared with infants who had preterm premature rupture of the membranes > 24 hours. CONCLUSION: Type 1 or type 2 retinopathy of prematurity are adverse ocular outcomes linked with not only lower gestational age and birth weight at delivery but also with events in the intrauterine environment that trigger a preterm birth. The reduced incidence of type 1 or type 2 retinopathy of prematurity in the preterm premature rupture of the membranes group compared with other causes of preterm birth may be related to the perinatal therapies associated with preterm premature rupture of the membranes (such as corticosteroids, antibiotics, maternal-fetal surveillance), which may have an inhibitory effect on the development of retinopathy of prematurity. We suggest that the physiologic events that predispose infants to type 1 or type 2 retinopathy of prematurity begin before delivery. SN - 1097-6868 UR - https://www.unboundmedicine.com/medline/citation/28545834/The_relationship_of_the_subtypes_of_preterm_birth_with_retinopathy_of_prematurity_ DB - PRIME DP - Unbound Medicine ER -