Association of postnatal dexamethasone use and fungal sepsis in the development of severe retinopathy of prematurity and progression to laser therapy in extremely low-birth-weight infants

Abstract

Objective: The objective of this study was to evaluate the role of postnatal dexamethasone use and fungal sepsis in the development of severe retinopathy and progression to laser therapy. Background: Postnatal steroids have been frequently used in the management of infants with chronic lung disease, airway edema, and hypotension, but their use is not free from adverse effects. Postnatal dexamethasone use has been associated with increased risk for the development of fungal sepsis, but the influence of glucocorticoid therapy on retinopathy of prematurity (ROP) is controversial. Candida sepsis has been shown to be associated with severe ROP and the need for laser therapy in some studies but not in others. Study Design: Medical records of all < 1000 g birth weight infants (n=158) admitted to Louisiana State University Health Sciences Center between July 1, 1996 and June 30, 1999 were reviewed. After exclusion of those infants who either died (n = 25) or transferred (n = 3) before eye examination, demographic and clinical data of 130 infants were analyzed by ξ-squared analysis, Mann-Whitney U test, t-test, analysis of variance, and logistic regression. All data are mean ± SD. Results: Gestational age was 26.4±1.7 weeks; birth weight was 797±130 g. Twenty-six infants were Caucasian, the rest African-American. Seventy-five (58%) received antenatal steroids. Eighty-eight (68%) of the infants received postnatal steroids. All infants were exclusively fed premature infant formulae. Sepsis developed in 44 (34%) infants and fungal sepsis in 14 (11%). Incidence of ROP was 77% (100/130), severe ROP (stage≥3) 52% (68). Severe ROP was more frequent in Caucasian infants (p=0.005) and in infants who received postnatal dexamethasone (p≤0.0001). The development of threshold ROP (zone 1 or 2 with stage 3+, five contiguous or eight total clock hours of the retina) and requirement for laser therapy were higher in Caucasians (p=0.0002) and in infants with fungal sepsis (p = 0.001). Antenatal steroids had no effect on the severity of ROP or the need for laser treatment. Postnatal dexamethasone use was significantly associated with fungal sepsis 13/14 (93%). After controlling for gestational age, race, days on supplemental oxygen, and fungal sepsis, cumulative postnatal dexamethasone use was independently associated with severe ROP [ OR 1.2 (1.04-1.33) ], and fungal sepsis [ OR 8.2 (2.0-33.0) ] was independently associated with the need for laser therapy. Conclusions: Postnatal steroid use is an independent risk factor for development of severe ROP. The risk of threshold ROP requiring laser treatment was higher in infants who developed fungal sepsis.