Dankhara Nilesh, Kalikkot Thekkeveedu Renjithkumar, Patel Jaimin, Desai Jagdish
Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA.
Biomed Hub. 2022 Jan 31;7(1):24-30. doi: 10.1159/000521413. eCollection 2022.
Retinopathy of prematurity (ROP) and infantile hemangiomas (IHs) both have similar proposed pathophysiological mechanisms. IH is more common in preterm than term infants. Hypoxia-induced mediators like vascular endothelial growth factor have been found elevated in children with hemangiomas. The aim of our study was to determine if there is an association between ROP and IH in preterm infants and to investigate racial/ethnic and gender differences of ROP and IHs in this cohort.
We accessed the national multicenter Kids' Inpatient Database (KID) Healthcare Cost and Utilization Project (HCUP) including admissions at age ≤28 days. Eligible infants were identified by using ICD-9 codes of ROP and IH in infants with gestational age (GA) ≤32 weeks and/or birth weight ≤1,500 g during the years 2003, 2006, 2009, and 2012. A weight-based analysis was performed using SAS Enterprise Guide 7.1 for complex sample design.
In the cohort of 1,068,502 eligible infants, the prevalence of IH was 4.7 per 1,000 preterm admissions (<32 weeks). ROP prevalence was 16% for GA ≤26 weeks, 12.5% for GA 27-30 weeks, and 2.7% for GA 31-32 weeks. IH was significantly higher in infants with ROP; this relationship was consistent among all stages of ROP. Regression analysis showed that females are at increased risk of IH with ROP compared to males (adjusted odds ratio [aOR]: 2.00 [1.85-2.56]). White non-Hispanic premature infants had an increased risk of IH with concomitant ROP compared to both African American (aOR: 3.9 [2.63-4.76]) and Hispanic (aOR: 1.2 [1.14-1.38]) infants. However, African American infants had an increased risk of ROP compared to white non-Hispanic infants (aOR: 1.16 [1.07-1.14]). These genders and racial/ethnic disparities were consistent among GA categories.
To our knowledge, this is the largest cohort based on a national multicenter database comparing an association between ROP and IH. A strong association between ROP and IH may suggest similar risk factors and/or pathophysiology. A further role of genetic factors could explain racial/ethnic differences in both conditions despite similar pathogenesis. These findings may open up new bases of research for management and prevention strategies.
早产儿视网膜病变（ROP）和婴儿血管瘤（IH）都有相似的病理生理机制。IH在早产儿中比足月儿更常见。在血管瘤患儿中发现缺氧诱导介质如血管内皮生长因子升高。我们研究的目的是确定早产儿中ROP和IH之间是否存在关联，并调查该队列中ROP和IH的种族/民族及性别差异。
我们访问了国家多中心儿童住院数据库（KID）医疗保健成本与利用项目（HCUP），包括年龄≤28天的住院病例。在2003年、2006年、2009年和2012年期间，通过使用ROP和IH的国际疾病分类第九版（ICD - 9）编码，在孕周（GA）≤32周和/或出生体重≤1500克的婴儿中识别符合条件的婴儿。使用SAS Enterprise Guide 7.1对复杂样本设计进行基于权重的分析。
在1,068,502名符合条件的婴儿队列中，IH的患病率为每1000例早产住院病例（<32周）中有4.7例。GA≤26周时ROP患病率为16%，GA 27 - 30周时为12.5%，GA 31 - 32周时为2.7%。ROP患儿中IH的患病率显著更高；这种关系在ROP的所有阶段都一致。回归分析表明，与男性相比，女性患伴有ROP的IH的风险增加（调整后的优势比[aOR]：2.00 [1.85 - 2.56]）。与非裔美国婴儿（aOR：3.9 [2.63 - 4.76]）和西班牙裔婴儿（aOR：1.2 [1.14 - 1.38]）相比，非西班牙裔白人早产婴儿患伴有ROP的IH的风险增加。然而，与非西班牙裔白人婴儿相比，非裔美国婴儿患ROP的风险增加（aOR：1.16 [1.07 - 1.14]）。这些性别和种族/民族差异在GA类别中是一致的。
据我们所知，这是基于国家多中心数据库比较ROP和IH之间关联的最大队列。ROP和IH之间的强关联可能表明存在相似的风险因素和/或病理生理学。尽管发病机制相似，但遗传因素的进一步作用可以解释这两种情况中的种族/民族差异。这些发现可能为管理和预防策略开辟新的研究基础。
