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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 2  |  Page : 102-106

Postnatal weight gain as a predictor of retinopathy of prematurity in preterm babies


1 Department of Pediatrics, Mugda Medical College Hospital, Dhaka, Bangladesh
2 Department of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
3 Department of Ophthalmology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
4 Department of Neonatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh

Date of Submission28-Jan-2022
Date of Decision16-Feb-2022
Date of Acceptance09-Mar-2022
Date of Web Publication20-Apr-2022

Correspondence Address:
Mahboba Akther
Department of Pediatrics, Mugda Medical College Hospital, Mugda, Dhaka
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.jcn_13_22

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  Abstract 


Aims: The aim of this study is to observe the postnatal weight gain as a predictor of retinopathy of prematurity (ROP) in preterm babies. Materials and Methods: A prospective cohort study was conducted from October 2018 to March 2020 in the Department of Neonatology and Ophthalmology, BSMMU Shahbag, Dhaka. Preterm neonates whose gestational age (GA) <35 weeks and birth weight (BW) <2000 g were included in the study. Results: The frequency of ROP was 35%. Most of them had Stage 1 ROP 17 (52%), and second most cause was aggressive posterior ROP 8 (24%). Severe form of ROP is more in “postnatal weight gain not achieved group.” On bivariate analysis, postnatal weight gain, BW, gestation, sepsis, apnea, necrotizing enterocolitis, use of oxygen, continuous positive airway pressure, mechanical ventilation, and blood transfusion were significantly associated with ROP. Not achieving postnatal weight gain and low gestation were significantly associated with ROP on logistic regression analysis. Conclusion: Not achieving postnatal weight gain and low GA are a predictor of retinopathy of retinopathy.

Keywords: Low birth weight, preterm, retinopathy of prematurity, weight gain


How to cite this article:
Akther M, Tabrez MS, Choudhury N, Moni SC, Dey SK, Jahan I, Hassan Shabuj MK, Shahidullah M, Mannan MA. Postnatal weight gain as a predictor of retinopathy of prematurity in preterm babies. J Clin Neonatol 2022;11:102-6

How to cite this URL:
Akther M, Tabrez MS, Choudhury N, Moni SC, Dey SK, Jahan I, Hassan Shabuj MK, Shahidullah M, Mannan MA. Postnatal weight gain as a predictor of retinopathy of prematurity in preterm babies. J Clin Neonatol [serial online] 2022 [cited 2022 Dec 6];11:102-6. Available from: https://www.jcnonweb.com/text.asp?2022/11/2/102/343417




  Introduction/Background Top


Preterm delivery occurs in 14% pregnancies in Bangladesh.[1] Retinopathy of prematurity (ROP) is one of the common complications of premature delivery. The incidence of ROP in Bangladesh is 23.7%, whereas in India, it is 24%–47%.[2],[3] The various common risk factors of ROP have been analyzed in different studies.[4]

Very low birth weight (VLBW) and low gestational age (GA) are most commonly associated with severe ROP.[5] The relation of slowed postnatal growth with ROP has been established in multiple studies.[6],[7]

Objectives

The study was designed to see the postnatal weight gain as a predictor of ROP in preterm babies.


  Materials and Methods Top


This prospective cohort study was conducted in our department of neonatology from October' 2018 to March' 2020 over 18 months' period after approval by Institutional Review Board.

Study procedures

A written informed consent was obtained from parents and ensured about confidentiality. After taking consent from the parents/guardians, neonates were enrolled in the study. Thorough history of these newborns including demographic and socioeconomic information's were obtained at the time of enrollment. Preterm neonates whose GA <35 weeks and BW <2000 g were included in the study. Newborns with congenital anomalies, suspected inborn errors of metabolism, and death before first ophthalmologic examination excluded from the study [Flow Chart 1]. ROP screening was done at 20 days of age whose BW <1200 g or GA <30 weeks and at 30 days of age whose BW <2000 g or GA <35 weeks by ophthalmologist by indirect ophthalmoscope (Heine omega 500). Detailed history regarding demographic and socioeconomic information, baseline neonatal characteristics, maternal clinical information, and perinatal and postnatal history were documented. GA was assessed by New Ballard Score.



The newborn infants' weight was taken without clothing soon after birth by an electronic weighing machine with a precision of 10 g (Model 914, SALTER). Those babies whose birth could not be attended weight were taken within 12 h of birth. All the postnatal events apnea, sepsis, necrotizing enterocolitis (NEC), and postnatal management, i.e., oxygen supplementation, continuous positive airway pressure (CPAP) care, mechanical ventilation, and blood transfusion were carefully recorded from the infants medical records.

The babies were divided into two groups at 3 weeks of postnatal age postnatal weight gain achieved group (BW regain at 3 weeks) and postnatal weight gain not achieved group (BW not regain at 3 weeks). The baby who regained BW at 3 weeks of postnatal age whether physiological or pathological was assessed by history (low urine output, got minimum amount calorie which was not sufficient for gaining weight) and examination (had puffy eye lid, pedal edema, and low urine output).

The babies who were discharged at home before 3 weeks their adequacy of breastfeeding were assessed by history of exclusive breastfeeding and urine output by examination when came for F/U or over telephone thrice weekly.

ROP screening was done according to protocol of our neonatal intensive care unit (NICU), by trained ophthalmologist by indirect ophthalmoscope (Heine omega 500). Dilatation of the pupils was achieved by instilling one drop of tropic amide and phenylephrine sterile eye drop two times at 5 min intervals in 1 h before ophthalmic examination. During an ophthalmologic examination, the staging of ROP was done by using the international classification of ROP.

Follow-up examination was done according to the stages of ROP. In severe ROP (Stage 3 and above), aggressive posterior ROP (APROP), threshold, and prethreshold ROP, the eyes were examined every week and in mild ROP (Stage 1 and 2) every 2–4 weeks. Those patients diagnosed with severe ROP (Stage 3 and above, APROP, and threshold and prethreshold ROP) got treatment accordingly in ophthalmology department.

Statistical consideration and data analysis

All the data were recorded in a preformed questionnaire and were analyzed by the Statistical Package for the Social Sciences (SPSS) version 20.0 (IBM SPSS Statistics- Property of IBM Corp., Chicago, Illinois, United States). Quantitative data were expressed as mean ± standard deviation and categorical data were presented as proportion. All quantitative variables were compared by unpaired t-test; categorical variables were compared by the Chi-square test or Fisher's exact test. P < 0.05 will be considered statistically significant. To determine the independent predictors of outcome multivariate logistic regression analysis were performed, using variables found to be significant on bivariate analysis. Odds ratio and 95% confidence interval (CI) calculated.


  Results Top


During the study period, 124 inborn admitted preterm (<35 weeks) and low BW (<2000 g) neonates were assessed for eligibility. After exclusion, 114 neonates were enrolled and followed up. At 3 weeks of postnatal age, weight was taken among 100 neonates because 14 babies were excluded. After the exclusion of 6 infants, 94 neonates, 49 were in “postnatal weight gain achieved group,” and 45 were in “postnatal weight gain not achieved group.” Neonates who underwent their 1st screening were advised for subsequent screening by ophthalmologist according to their suggestion.

Among the studied neonates, mean BW was 1446.44 ± 253.1 and GA was 32.49 ± 1.6 weeks. Regarding sex, 55% were male and 45% were female. Among neonates of 17% were delivered by normal vaginal delivery (NVD) and 83% were born by Lower uterine caeserian section (LUCS).

The incidence of ROP was 35% (33) Among the 33 neonates who developed ROP, 52% (17) developed mild ROP, the second most type of ROP was AP ROP were 24% (8) and then Type 2 ROP 18% (6) and only one neonates Stage 3 ROP 3% (1), threshold ROP 3% (1).

[Table 1] and [Table 2] showed in bivariate analysis BW, gestation, newborns whose postnatal weight gain not achieved, apnea, neonatal sepsis, NEC, supplemental oxygen, use of CPAP, mechanical ventilation, and blood transfusion were significantly associated with the development of ROP. However, sex and maternal factors such as pregnancy-induced hypertension, gestational diabetes mellitus, and status of antenatal corticosteroid had no significant relationship with ROP.
Table 1: Bivariate analysis of maternal factors associated with retinopathy of prematurity (n=94)

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Table 2: Bivariate analysis of neonatal factors associated with retinopathy of prematurity (n=94)

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  Discussion Top


ROP is one of the major causes of blindness in infants and children in developed countries and has emerged as a problem in developing countries as well. Due to the advancement of neonatal care, survival of premature and VLBW neonates have been increasing.[8] It is an important cause of potentially preventable blindness in developed countries.[9] In this study, the overall incidence of ROP was 35%. The finding was found to be nearly similar in the studies conducted in developing countries such as India where the incidence of ROP had been reported at 24%–47% among high risk preterm infants. This is because of inclusion of hospitalized sick premature newborns and also strict adherence to ROP screening protocol.

Among 33 neonates who developed ROP, most of them developed Stage I ROP 17 (52%), then AP-ROP 8 (24%), Stage II ROP 6 (18%) and only 1 (3%) developed Stage III ROP,1 (3%) developed threshold ROP. There was similar finding done from January 2014 to June 2015 in our NICU, but the Stage III ROP was more in his study which was decreased.[10] This is because neonates were identified in earlier stage so less chance of severe form of ROP.

The neonates who did not achieve postnatal weight gain defined by not regaining BW at 3 weeks of postnatal age has significant no of ROP, 23 (51%) among the 45 neonates versus 10 (23%) of 49 neonates who achieved postnatal weight gain by regaining BW at 3 weeks of life in univariate analysis (P = 0.002). In logistic regression analysis, postnatal weight gain not achieved group found to be an independent predictor of development of ROP (odds' ratio: 3.71; 95% CI: 1.47–9.35, P = 0.005) [Table 3].
Table 3: Logistic regression analysis of factors associated with retinopathy of prematurity

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There were studies reported a relationship between poor postnatal weight gain and increased risk of developing ROP. Poor absolute weight gain (g/day) but not relative weight gain in the first 6 weeks was associated with threshold ROP.[11] Another study reported that low weight gain proportion at 6 weeks could predict severe ROP in VLBW infants.[12]

GA was found statistically significant (P = 0.016) in univariate analysis. The neonate who had low gestation (<32 weeks) had more chance of ROP 12 (58%) among 21 neonates versus 21 (29%) among the 73 neonates of gestation 32–35 weeks [Table 3]. In logistic regression analysis also found significant association with ROP (odds: 3.05; 95% CI: 1.03–9.02; P = 0.043). Although some studies in developing countries did not find significant relationship between GA and ROP.[13] In some studies of ROP, lower GA was found to be a significant risk factor.[14] The finding of our study regarding GA was consistent with the study done by Dani et al.

On bivariate analysis of other risk factors such as BW, sepsis, apnea, NEC, use of oxygen, CPAP, MV, and blood transfusion was also significantly associated ROP. However, logistic regression analysis found no significant relation.


  Conclusion Top


Not achieving postnatal weight gain is an independent predictor for the development of ROP. Low GA is also a risk factor of development of ROP.

Acknowledgment

The authors would like to thank the Department of Ophthalmology for their support for doing ROP.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Blencowe H, Cousens S, Oestergaard MZ, Chou D, Moller AB, Narwal R, et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: A systematic analysis and implications. Lancet 2012;379:2162-72.  Back to cited text no. 1
    
2.
Shahidullah M, Dey AC, Ahmed F, Jahan I, Dey SK, Choudhury N, et al. Retinopathy of prematurity and its association with neonatal factors. Bangabandhu Sheikh Mujib Med Univ J 2017;10:1-4.  Back to cited text no. 2
    
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Varughese S, Jain S, Gupta N, Singh S, Tyagi V, Puliyel JM. Magnitude of the problem of retinopathy of prematurity. Experience in a large maternity unit with a medium size level-3 nursery. Indian J Ophthalmol 2001;49:187-8.  Back to cited text no. 3
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4.
Wani VB, Kumar N, Sabti K, Raizada S, Rashwan N, Shukkur MM, et al. Results of screening for retinopathy of prematurity in a large nursery in Kuwait: Incidence and risk factors. Indian J Ophthalmol 2010;58:204-8.  Back to cited text no. 4
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Rekha S, Battu RR. Retinopathy of prematurity: Incidence and risk factors. Indian Pediatr 1996;33:999-1003.  Back to cited text no. 5
    
6.
VanderVeen DK, Martin CR, Mehendale R, Allred EN, Dammann O, Leviton A, et al. Early nutrition and weight gain in preterm newborns and the risk of retinopathy of prematurity. PLoS One 2013;8:e64325.  Back to cited text no. 6
    
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Stoltz Sjöström E, Lundgren P, Öhlund I, Holmström G, Hellström A, Domellöf M. Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed 2016;101:F108-13.  Back to cited text no. 7
    
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Brooks SE, Marcus DM, Gillis D, Pirie E, Johnson MH, Bhatia J. The effect of blood transfusion protocol on retinopathy of prematurity: A prospective, randomized study. Pediatrics 1999;104:514-8.  Back to cited text no. 8
    
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Manzoni P, Farina D, Maestri A, Giovannozzi C, Leonessa ML, Arisio R, et al. Mode of delivery and threshold retinopathy of prematurity in pre-term ELBW neonates. Acta Paediatr 2007;96:221-6.  Back to cited text no. 9
    
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Bhuiyan AN, Mannan MA, Dey SK, Choudhury N, Shameem M, Shahidullah M. Frequency and risk factors for retinopathy of prematurity in very low birth weight infants in NICU, BSMMU. TAJ J Teach Assoc 2019;32:54-61.  Back to cited text no. 10
    
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Allegaert K, Vanhole C, Casteels I, Naulaers G, Debeer A, Cossey V, et al. Perinatal growth characteristics and associated risk of developing threshold retinopathy of prematurity. J AAPOS 2003;7:34-7.  Back to cited text no. 11
    
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Fortes Filho JB, Bonomo PP, Maia M, Procianoy RS. Weight gain measured at 6 weeks after birth as a predictor for severe retinopathy of prematurity: Study with 317 very low birth weight preterm babies. Graefes Arch Clin Exp Ophthalmol 2009;247:831-6.  Back to cited text no. 12
    
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Adriono GA, Sitorus RS. Screening for retinopathy of prematurity at Cipto Mangunkusumo Hospital, Jakarta, Indonesia – A preliminary report. Acta Med Litu 2006;13.  Back to cited text no. 13
    
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Dani C, Reali MF, Bertini G, Martelli E, Pezzati M, Rubaltelli FF. The role of blood transfusions and iron intake on retinopathy of prematurity. Early Hum Dev 2001;62:57-63.  Back to cited text no. 14
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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