Cho Seohyun, Farghaly Mohsen A A, Ramey Stacey, Abdalla Alshimaa, Mohamed Mohamed A, Aly Hany
Neonatology Division, Cleveland Clinic Children's, Cleveland, OH, USA.
Pediatr Res. 2025 Aug 9. doi: 10.1038/s41390-025-04323-3.
The study aimed to examine the association of pulmonary hypertension (PH) and the use of inhaled nitric oxide (iNO) with retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants.
Utilizing the United States National Inpatient Sample (NIS) database, VLBW infants were identified. Chi-square and Fisher's exact tests were used to calculate unadjusted odds ratios (ORs) for the presence of ROP in relation to PH and iNO therapy. Adjusted odds ratios (aORs) were calculated using logistic regression while controlling for potential confounders.
Among 1,007,141 infants, 30,401 (3%) had PH. ROP was diagnosed more frequently with PH (22.3% vs 13.6%; aOR: 1.32, 95% CI: 1.28-1.36, p < 0.001). Severe ROP was less frequent in iNO-treated PH infants (4.33% vs 5.35%; aOR: 0.82, 95% CI: 0.70-0.96, p = 0.02). In extremely low birth weight (ELBW) infants with PH, iNO use was associated with lower rates of severe ROP (aOR: 0.68, 95% CI: 0.57-0.81, p < 0.001).
PH is associated with an increased risk of ROP. iNO therapy is associated with a decreased prevalence of severe ROP in PH-affected infants. Further studies are needed to assess the early use of vascular modulators in mitigating the risk for ROP.
Premature infants diagnosed with pulmonary hypertension are at increased risk for ROP. Severe ROP is less encountered when inhaled nitric oxide was used in this vulnerable population. This is the first study to assess the interaction between pulmonary hypertension, its treatment, and the development of ROP in premature infants. The study suggests the need for future studies to assess the efficacy of early use of vascular modulators in mitigating the risk of ROP.
本研究旨在探讨极低出生体重（VLBW）婴儿的肺动脉高压（PH）及吸入一氧化氮（iNO）的使用与早产儿视网膜病变（ROP）之间的关联。
利用美国国家住院样本（NIS）数据库确定VLBW婴儿。采用卡方检验和费舍尔精确检验计算与PH和iNO治疗相关的ROP存在情况的未调整优势比（OR）。在控制潜在混杂因素的同时，使用逻辑回归计算调整后的优势比（aOR）。
在1,007,141名婴儿中，30,401名（3%）患有PH。PH患儿中ROP的诊断更为频繁（22.3%对13.6%；aOR：1.32，95%置信区间：1.28 - 1.36，p < 0.001）。接受iNO治疗的PH婴儿中重度ROP的发生率较低（4.33%对5.35%；aOR：0.82，95%置信区间：0.70 - 0.96，p = 0.02）。在患有PH的极早早产儿（ELBW）中，使用iNO与较低的重度ROP发生率相关（aOR：0.68，95%置信区间：0.57 - 0.81，p < 0.001）。
PH与ROP风险增加相关。iNO治疗与受PH影响婴儿中重度ROP患病率降低相关。需要进一步研究以评估早期使用血管调节剂降低ROP风险的效果。
诊断为肺动脉高压的早产儿患ROP的风险增加。在这一脆弱人群中使用吸入一氧化氮时，重度ROP较少见。这是第一项评估肺动脉高压及其治疗与早产儿ROP发生之间相互作用的研究。该研究表明未来需要进行研究以评估早期使用血管调节剂降低ROP风险的疗效。
