Impact of postnatal steroids on peripheral avascular retina and severity of retinopathy of prematurity

Prem S Shekhawat; Mahmoud A M Ali; Naveen Kannekanti; Hannah Koechley; Christiane Mhanna; Merlin Pinto; Mohsen A A Farghaly; Maroun Mhanna; Hany Z Aly; Jonathan E Sears

doi:10.1038/s41390-023-02673-4

Impact of postnatal steroids on peripheral avascular retina and severity of retinopathy of prematurity

Pediatr Res. 2023 Dec;94(6):1966-1972. doi: 10.1038/s41390-023-02673-4. Epub 2023 Jun 8.

Authors

Prem S Shekhawat¹, Mahmoud A M Ali², Naveen Kannekanti², Hannah Koechley^{2

3}, Christiane Mhanna^{2

4}, Merlin Pinto², Mohsen A A Farghaly^{2

4}, Maroun Mhanna^{2

5}, Hany Z Aly⁴, Jonathan E Sears^{6

7}

Affiliations

¹ Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, 44109, USA. pshekhawat@metrohealth.org.
² Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, 44109, USA.
³ School of Medicine, Wright State University, Dayton, OH, 45402, USA.
⁴ Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, OH, 44106, USA.
⁵ Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, 71103, USA.
⁶ Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, 44106, USA.
⁷ Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, OH, 44195, USA.

PMID: 37291231
DOI: 10.1038/s41390-023-02673-4

Abstract

Background: We investigated the role of postnatal steroids on the severity of retinopathy of prematurity (ROP) and its impact on peripheral avascular retina (PAR).

Methods: A retrospective cohort study of infants born at ≤32 weeks gestation and/or birth weight ≤1500 g. Demographics, the dose and duration of steroid treatment, and age when full retinal vascularization occurred were collected. The primary outcomes were the severity of ROP and time to full vascularization of the retina.

Results: A total of 1695 patients were enrolled, 67% of whom received steroid therapy. Their birth weight was 1142 ± 396 g and gestational age was 28.6 ± 2.7 weeks. The total hydrocortisone-equivalent dose prescribed was 28.5 ± 74.3 mg/kg. The total days of steroid treatment were 8.9 ± 35.1 days. After correction for major demographic differences, infants who received a higher cumulative dose of steroids for a longer duration had a significantly increased incidence of severe ROP and PAR (P < 0.001). For each day of steroid treatment, there was a 3.2% increase in the hazard of the severe form of ROP (95% CI: 1.022-1.043) along with 5.7% delay in achieving full retinal vascularization (95% CI: 1.04-1.08) (P < 0.001).

Conclusion: Cumulative dose and duration of postnatal steroid use were independently associated with the severity of ROP and PAR. Thus, postnatal steroids should be used very prudently.

Impact: We report ROP outcomes in a large cohort of infants from two major healthcare systems where we have studied the impact of postnatal steroids on the severity of ROP, growth, and development of retinal vessels. After correcting our data for three major outcome measures, we show that high-dose postnatal steroids used for a prolonged duration of time are independently associated with severe ROP and delay in retinal vascularization. Postnatal steroids impact the visual outcomes of VLBW infants significantly, so their clinical use needs to be moderated.

MeSH terms

Birth Weight
Gestational Age
Humans
Infant
Infant, Newborn
Retina
Retinal Neovascularization*
Retinopathy of Prematurity* / diagnosis
Retinopathy of Prematurity* / drug therapy
Retinopathy of Prematurity* / epidemiology
Retrospective Studies
Risk Factors
Steroids / therapeutic use

Substances

Steroids