title: Risk factors for severe retinopathy of prematurity in preterm low birth weight neonates.
abstract: OBJECTIVE
  To evaluate the risk factors predisposing to severe retinopathy of prematurity (ROP) in a level III neonatal unit. This retrospective study was conducted in a tertiary care neonatal and ophthalmic center.
  
  
  METHODS
  The authors retrospectively analyzed data of preterm infants who were born from January 2003 through December 2008 and were screened for ROP. Data were collected from prospectively filled ROP screening forms. All the neonates with gestation ≤ 32 wks or birth weight ≤ 1500 g were screened. In addition, infants with birth weight of 1501-1800 g or gestation of 33-34 wks were also screened in the presence of additional risk factors like need for oxygen or mechanical ventilation. Primary outcome was severe ROP defined as treatable ROP as per type I ETROP guidelines (after year 2005) or threshold disease (before 2005).
  
  
  RESULTS
  A total of 704 neonates were screened during the study period, of whom 84 (11.9%) and 33 (4.7%) infants developed any ROP and severe ROP, respectively. The mean birth weight and gestation of infants with severe ROP were 1113 ± 438 g and 29 ± 3 wks, respectively. The following risk factors were found to be significant for severe ROP on univariate analysis: gestation ≤ 30 wks, birth weight < 1000 g, respiratory distress syndrome, use of surfactant, apnea, hypotension, patent ductus arteriosus (PDA), sepsis, necrotizing enterocolitis, pneumonia, meningitis, intraventricular hemorrhage, packed cell transfusion, and use of oxygen, continuous positive airway pressure and positive pressure ventilation. On multivariate analysis by stepwise logistic regression, respiratory distress syndrome (adjusted OR: 8.1 (95% CI 2.6-25.1); p < 0.001), PDA requiring medical or surgical management (adjusted OR: 3.2 (95% CI 1.1-8.9); p = 0.03), and meningitis (adjusted OR: 6.7 (95% CI 1.9-23.0); p = 0.002) were found to be independently associated with severe ROP. All infants with severe ROP had regression of the disease after laser therapy.
  
  
  CONCLUSIONS
  Respiratory distress syndrome, PDA requiring medical or surgical management and meningitis were found to be associated with severe ROP. Outcomes were good after laser therapy with all followed-up infants having regression of the disease.
authors.affiliation: Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029, India.
authors.forename: Pardeep
authors.initials: P
authors.lastname: Kumar
authors.forename: M Jeeva
authors.initials: MJ
authors.lastname: Sankar
authors.forename: Ashok
authors.initials: A
authors.lastname: Deorari
authors.forename: Rajvardhan
authors.initials: R
authors.lastname: Azad
authors.forename: Parijat
authors.initials: P
authors.lastname: Chandra
authors.forename: Ramesh
authors.initials: R
authors.lastname: Agarwal
authors.forename: Vinod
authors.initials: V
authors.lastname: Paul
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D012178:Retinopathy of Prematurity / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors