Weight Gain Acceleration and Risk of Retinopathy of Prematurity
Sila Bal, BS; Gui-shuang Ying, PhD; Lauren Tomlinson, BS; Gil Binenbaum, MD
Children’s Hospital of Philadelphia
Introduction: Slow postnatal weight gain (WG), a surrogate for low IGF-1, is predictive of retinopathy of prematurity (ROP). Early low IGF-1 inhibits retinal vessel growth, but a later rise activates VEGF, causing neovascularization. The rate of IGF-1 rising is represented by WG acceleration. We evaluated if faster WG acceleration later in life is associated with a higher, rather than lower, risk of severe ROP.
Methods: Retrospective cohort study at 29 North American hospitals, 2006-12 (G-ROP Study). WG rate during PMA 29-33 weeks (WGR-29-33) and WG acceleration during weeks 34-38 (WGA-34-38) were determined using linear regression of daily weights. The association between WGA-34-38 and type 1 or 2 ROP was assessed.
Results: 6835 infants with adequate data were studied. 868(12.7%) severe ROP. Stratified by WGR-29-33 tertiles, the rate of ROP did not change with WGA for the lowest tertile; but for middle and high WGF-29-33 tertiles, rate of ROP increased with increasing WGA, except for the fastest (top 20%) growing infants.
Discussion: The relationship between weight gain and ROP is more complex than previously thought. Timing and rate of IGF-1 increases are important and would impact potential therapeutic measures.
Conclusion: The effect of WGA on ROP depends on WGR earlier in postnatal development. Low WGR-29-33 is associated with severe ROP regardless of subsequent WGA. But if WGR-29-33 is moderate or high, subsequent rapid rises in WGR are associated with increasing risk of severe ROP.
References: Binenbaum G., Tomlinson L., Design of the G-ROP Study. Ophthalmic Epidemiology 2017.