Mohsen L, Abou-Alam M, El-Dib M, Labib M, Elsada M, Aly H
Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.
Department of Neonatology, The George Washington University and Children's National Medical Center, Washington, DC, USA.
J Perinatol. 2014 Jun;34(6):453-7. doi: 10.1038/jp.2014.49. Epub 2014 Mar 27.
Retinopathy of prematurity (ROP) constitutes a significant morbidity in premature infants that can lead to blindness. Multiple retrospective studies have identified neonatal hyperglycemia as a risk for developing ROP. However, in the absence of any reported prospective study, it is not clear whether hyperglycemia is associated with ROP independent of the commonly associated comorbidities. The objective of this study was to investigate whether hyperglycemia in premature infants is independently associated with ROP.
Premature infants (<1500 g or⩽32 weeks gestational age) were enrolled in a prospective longitudinal cohort study. All demographic, clinical and laboratory data were collected. Bedside whole-blood glucose concentration was measured every 8 h daily for 7 days. For any glucose reading<50 or>150 mg dl(-1), serum sample was sent to the laboratory for confirmation. Hyperglycemia was defined as any blood glucose level⩾150 mg dl(-1). ROP patients were compared with non-ROP patients in a bivariate analysis. Variables significantly associated with ROP were studied in a logistic regression model.
A total of 65 patients were enrolled with gestational age 31.1±1.2 weeks and birth weight 1385±226 g. Thirty-one patients (48%) were identified with hyperglycemia. On eye examination, 19 cases (29.2%) had ROP (13 with stage 1, 4 with stage 2 and 2 with stage 3). There were more cases of ROP in the hyperglycemia group compared with the euglycemia group (45% vs 15%, P=0.007). Patients who developed ROP had significantly higher maximum and average glucose concentrations when compared with non-ROP patients. Multiple factors have been associated with ROP on bivariate analysis, including gestational age, exposure to oxygen, respiratory support and poor weight gain. However, in a logistic regression model including all significant variables, average blood glucose in the first week of life was the factor independently associated with ROP with an odds ratio of: 1.77 (95% confidence interval: 1.08 to 2.86), P=0.024.
In a cohort of premature infants, elevated average blood glucose concentrations in the first week of life is independently associated with the development of ROP.
早产儿视网膜病变（ROP）是导致早产儿失明的一种严重疾病。多项回顾性研究已确定新生儿高血糖是发生ROP的一个风险因素。然而，由于尚无前瞻性研究报道，目前尚不清楚高血糖是否独立于常见的合并症与ROP相关。本研究的目的是调查早产儿高血糖是否与ROP独立相关。
将早产儿（<1500g或胎龄≤32周）纳入一项前瞻性纵向队列研究。收集所有人口统计学、临床和实验室数据。每天每8小时测量一次床边全血葡萄糖浓度，持续7天。对于任何血糖读数<50或>150mg/dl（-1）的情况，将血清样本送检以进行确认。高血糖定义为任何血糖水平≥150mg/dl（-1）。在双变量分析中，将ROP患者与非ROP患者进行比较。在逻辑回归模型中研究与ROP显著相关的变量。
共纳入65例患者，胎龄31.1±1.2周，出生体重1385±226g。31例患者（48%）被诊断为高血糖。眼部检查发现，19例（29.2%）患有ROP（13例为1期，4例为2期，2例为3期）。与血糖正常组相比，高血糖组的ROP病例更多（45%对15%，P=0.007）。与非ROP患者相比，发生ROP的患者的最高和平均血糖浓度显著更高。在双变量分析中，多个因素与ROP相关，包括胎龄、吸氧、呼吸支持和体重增加不佳。然而，在包含所有显著变量的逻辑回归模型中，出生后第一周的平均血糖是与ROP独立相关的因素，比值比为：1.77（95%置信区间：1.08至2.86），P=0.024。
在一组早产儿中，出生后第一周平均血糖浓度升高与ROP的发生独立相关。
