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  • Clinical Research Article
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Impact of postnatal steroids on peripheral avascular retina and severity of retinopathy of prematurity

Pediatric Research volume 94, pages 1966–1972 (2023)Cite this article

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.

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Fig. 1: Recruitment of study subjects.
Fig. 2: Kaplan–Meir curve showing time taken for full retinal vascularization in steroid-exposed neonates (red) versus unexposed neonates (blue).
Fig. 3: Relationship between total hydrocortisone dose and total days on steroids with corrected gestational age when full retinal vascularization occurred.

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Data availability

The authors agree to share deidentified patient data and statistical analysis on request by other investigators after obtaining permission from each healthcare system. Data will be made available by the corresponding author.

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Funding

The study was funded in part by NIH grant UL1 TR002548 from NCATS/NIH, which provided us REDcap (Research electronic data capture) software used for data storage, analysis, and sharing.

Author information

Author notes

  1. Maroun Mhanna

    Present address: Department of Pediatrics, Louisiana State University Health Sciences Center, Shreveport, LA, 71103, USA

Authors and Affiliations

  1. Department of Pediatrics, Division of Neonatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, 44109, USA

    Prem S. Shekhawat, Mahmoud A. M. Ali, Naveen Kannekanti, Hannah Koechley, Christiane Mhanna, Merlin Pinto, Mohsen A. A. Farghaly & Maroun Mhanna

  2. School of Medicine, Wright State University, Dayton, OH, 45402, USA

    Hannah Koechley

  3. Department of Neonatology, Cleveland Clinic Children’s Hospital, Cleveland, OH, 44106, USA

    Christiane Mhanna, Mohsen A. A. Farghaly & Hany Z. Aly

  4. Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, 44106, USA

    Jonathan E. Sears

  5. Cardiovascular and Metabolic Sciences, Cleveland Clinic, Cleveland, OH, 44195, USA

    Jonathan E. Sears

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Contributions

Data collection was performed by the following authors: M.A.M.A., N.K., H.K., C.M., M.P., and M.A.A.F. All authors participated in the concept and design, analysis and interpretation of data, and drafting and revising of the manuscript.

Corresponding author

Correspondence to Prem S. Shekhawat.

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The authors declare no competing interests.

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This is a retrospective cohort study so both IRBs exempted us from obtaining consent from the patients.

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Shekhawat, P.S., Ali, M.A.M., Kannekanti, N. et al. Impact of postnatal steroids on peripheral avascular retina and severity of retinopathy of prematurity. Pediatr Res 94, 1966–1972 (2023). https://doi.org/10.1038/s41390-023-02673-4

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