medwireNews: Neonatal sepsis is associated with retinopathy of prematurity (ROP). Its need for treatment in very preterm infants and the number of episodes that occur matters, researchers have found.
The results are not only in keeping with data from previous studies, but are also the first to describe a possible dose–response relationship between the number of sepsis episodes and increases in the odds of both ROP and ROP that warrants treatment, Kirsten Glaser (University of Leipzig Medical Center, Germany) and co-investigators report in JAMA Network Open.
ROP is a major morbidity of preterm infants and is already associated with known risk factors, such as low gestational age, low birth weight, poor postnatal growth, hyperoxia, and hypoxia. These findings now “suggest that recurrent culture–proven sepsis ought to be acknowledged as a preventable risk factor,” say the researchers.
They used data from two large-scale cohorts of preterm infants – 12,794 preterm infants from the German Neonatal Network and 1844 from the Norwegian Neonatal Network – all of whom were born before 29 weeks of gestation between January 2009 and December 2022 and December 2018, respectively.
Just under half (49.8%) of the preterm infants in the German cohort and a third (33.6%) of those in the Norwegian cohort had ROP, with treatment required in a respective 6.6% and 7.6% of cases.
“In both cohorts, there were increasing rates of treatment-warranted ROP with each sepsis episode,” observe Glaser and co-workers.
In the German and Norwegian cohorts, respectively, treatment-warranted ROP occurred in 5.4% and 5.7% of infants who had no episodes of sepsis, 10.9% and 9.9% of those who experienced one episode, 16.9% and 26.5% of those who had two episodes, and 29.8% and 30.0% of those who had three episodes.
It was only in the German cohort, however, that the number of sepsis episodes was significantly associated with both ROP after multivariable adjustment for gestational age and weight, sex, multiple birth status, antenatal steroids, Apgar score, inborn status, maximum fraction of inspired oxygen in the first 12 hours of life, need for inotropes in the first 24 hours, and other risk factors, with adjusted odds ratios (OR) of 1.44 for one, 1.81 for two, and 4.39 for three sepsis episodes.
The corresponding OR for treatment-warranted ROP were 1.60, 2.38 and 3.88, all of which were statistically significant.
And these were confirmed by a propensity score matching analysis, where the adjusted ORs for having ROP or treatment-warranted ROP after one versus no episodes of sepsis were a respective 1.76 and 1.90, and a respective 1.58 and 1.41 when comparing both two and three episodes with one or no episodes.
Although similar results were initially seen in the Norwegian cohort, the effect was lost after adjusting for other variables associated with increased risk for ROP, say the researchers. However, they did find that surgery for necrotizing enterocolitis was associated with a more than threefold risk for treatment-warranted ROP.
The researchers acknowledge that their findings are limited by the small sample size and the “evolution of neonatal care” over the study period, and that confirmatory “large and well-powered studies” are required.
Nevertheless, they suggest that their findings “highlight once more the importance of sepsis prevention in preterm infants.”
They conclude: “Additionally, our results emphasize the necessity to consider neonatal sepsis as a risk factor in ROP screening policies in very preterm infants.”
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