Assessing the Surgical Experience to Identify Risk Factors Associated with Severe Retinopathy of Prematurity and Laser Intervention

Abstract

Background: Retinopathy of prematurity (ROP) is a known complication of preterm birth and one of the leading causes of blindness. Known risk factors include low gestational age (GA), birth weight, and oxygen exposure. It is unknown if there are surgical risk factors associated with severe ROP.

Objectives: Identify risk factors of a neonatal surgical exposure associated with laser therapy for ROP.

Methods: Institutional review of 76 infants with GA ≤27 weeks or birth weight ≤800 g. Infant demographics and details of surgical experience were collected. Infants who underwent a surgical procedure were analyzed to identify risk factors associated with laser treatment for severe ROP. Surgical and nonsurgical infants were compared to assess if the rate of laser intervention differed among institutions/published data. Data were analyzed using the Mann-Whitney U test, unpaired t test, OR and Fischer's exact test.

Result: Out of 49 surgical infants, 11 underwent laser intervention. Infants undergoing laser had surgery at an earlier postmenstrual age (PMA; 31.5 [29.3-39.4] weeks vs. 38.1 [31.3-42.5] weeks, p = 0.01), were more likely to have an exploratory laparotomy (adjusted odds ratio 1.3 [1.04-1.64], p = 0.02), and to undergo more surgical procedures (3 vs. 2, p = 0.04).

Conclusion: At our institution, preterm infants who undergo a surgical procedure prior to 32 weeks PMA and those having ≥3 surgeries were at a higher risk for progressing to laser intervention. Additional studies with larger sample sizes are needed to assess if the risk factors we have identified remain significant and to identify other possible risk factors.

Keywords: Laser; Retinopathy of prematurity; Risk Factors; Surgery.