Insulin, Hyperglycemia, and Severe Retinopathy of Prematurity in Extremely Low-Birth-Weight Infants.
OBJECTIVE
This study aims to determine the association between hyperglycemia, insulin therapy, and severe retinopathy of prematurity (ROP) in extremely low-birth-weight (ELBW) infants.


METHODS
In this retrospective database study, we included all ELBW infants who were ≤ 32 weeks gestational age (GA). We excluded infants without any ophthalmology evaluation and infants who died before 28 days of life. A multivariable model was constructed to determine the association between hyperglycemia, insulin use, and severe ROP. We defined hyperglycemia as blood glucose (BG) > 180 mg/dL. Covariates were GA, small for GA status, discharge year, sex, Apgar score at 5 minutes, mechanical ventilation, oxygen use, bacteremia, and postnatal steroid exposure. We defined severe ROP as ROP requiring bevacizumab, cryotherapy, laser therapy, or vitrectomy. Sensitivity analysis using BG > 150 mg/dL and > 200 mg/dL was performed.


RESULTS
A total of 24,548 infants were included; 2,547 (10%) had severe ROP. Hyperglycemia alone was not associated with severe ROP (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.66-1.17). Hyperglycemia and insulin use were not associated with severe ROP (OR, 1.43; 95% CI, 0.91-2.23). BG > 150 mg/dL and insulin use were associated with severe ROP (OR, 1.34; 95% CI, 1.02-1.76).


CONCLUSIONS
Hyperglycemia alone was not associated with severe ROP in ELBW infants. However, we did observe a possible trend between the use of insulin and severe ROP.
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
Jan Hau
JH
Lee
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
Christoph P
CP
Hornik
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
Daniela
D
Testoni
Department of Pediatrics, University of North Carolina, Chapel Hill, North Carolina.
Matthew M
MM
Laughon
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
C Michael
CM
Cotten
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
Ramiro S
RS
Maldonado
Pediatrix Medical Group, MEDNAX, Inc., Jacksonville, Florida.
Marc R
MR
Belcastro
Pediatrix Medical Group, MEDNAX, Inc., Jacksonville, Florida.
Reese H
RH
Clark
Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina.
P Brian
PB
Smith
D001034:Apgar Score; D001786:Blood Glucose / Q000032:analysis; D016208:Databases, Factual; D005260:Female; D005865:Gestational Age; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology*; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007328:Insulin / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012178:Retinopathy of Prematurity / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors
D001786:Blood Glucose; D007328:Insulin