Abstract

Objectives: Poor weight gain during the first weeks of life in preterm infants is associated with the risk of developing retinopathy of prematurity (ROP). Our study aimed to evaluate the effect of energy, macronutrient intake, and weight gain during the first 4 weeks of life on the risk of ROP.

Methods: This study was designed as a single-center, retrospective, and case-control trial. Premature babies, born before the 30th week of gestation, were included in our study. The infants were divided into three groups: control (without ROP), mild ROP, and severe ROP groups. Possible nutritional risk factors for ROP were compared.

Results: ROP was found in 32 (29.5%) of 108 infants included in this study. The first enteral feeding day, full enteral feeding day, and total duration of parenteral nutrition were significantly higher in infants with level 3-4 ROP than the others (p <0.05). The risk of severe ROP increased in infants who gained less than 8 g/day and who received less than 91 kcal/kg of calories (p <0.05). It was found that infants with severe ROP received statistically (p <0.05) less breast milk, but there was no difference in formula intake (p >0.05).

Conclusions: We showed that low energy intake during the first 4 weeks of life is an independent risk factor for severe ROP. This implies that the provision of adequate energy from parenteral and enteral sources during the first 4 weeks of life may be an effective method to reduce the risk of severe ROP in preterm infants.

Keywords: Retinopathy of prematurity, total parenteral nutrition, weight gain, premature

Copyright and license

How to cite

1.
Akın MŞ, Yiğit Ş. The effects of early nutritional contents in premature infants on the development and severity of retinopathy: A retrospective case-control study. Trends in Pediatrics. 2023;4(4):238-46. https://doi.org/10.59213/TP.2023.68442

References

  1. Hellström A, Smith LE, Dammann O. Retinopathy of prematurity. Lancet. 2013;382:1445-57. https://doi.org/10.1016/S0140-6736(13)60178-6
  2. Zin A, Gole GA. Retinopathy of prematurity-incidence today. Clin Perinatol. 2013;40:185-200. https://doi.org/10.1016/j.clp.2013.02.001
  3. Bas AY, Demirel N, Koc E, Ulubas Isik D, Hirfanoglu İM, Tunc T; TR-ROP Study Group. Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units. Br J Ophthalmol. 2018;102:1711-6. https://doi.org/10.1136/bjophthalmol-2017-311789
  4. Paysse EA, Garcia-Prats, JA, Saunders RA, editors. Retinopathy of Prematurity. Waltham, MA: UpToDate; 2014.
  5. Hellström A, Carlsson B, Niklasson A, et al. IGF-I is critical for normal vascularization of the human retina. J Clin Endocrinol Metab. 2002;87:3413-6. https://doi.org/10.1210/jcem.87.7.8629
  6. Cavallaro G, Filippi L, Bagnoli P, et al. The pathophysiology of retinopathy of prematurity: an update of previous and recent knowledge. Acta Ophthalmol. 2014;92:2-20. https://doi.org/10.1111/aos.12049
  7. Alajbegovic-Halimic J, Zvizdic D, Alimanovic-Halilovic E, Dodik I, Duvnjak S. Risk factors for retinopathy of prematurity in premature born children. Med Arch. 2015;69:409-13. https://doi.org/10.5455/medarh.2015.69.409-413
  8. Rekha S, Battu RR. Retinopathy of prematurity: incidence and risk factors. Indian Pediatr. 1996;33:999-1003.
  9. Gupta VP, Dhaliwal U, Sharma R, Gupta P, Rohatgi J. Retinopathy of prematurity-risk factors. Indian J Pediatr. 2004;71:887-92. https://doi.org/10.1007/BF02830827
  10. Stoltz Sjöström E, Lundgren P, Öhlund I, Holmström G, Hellström A, Domellöf M. Low energy intake during the first 4 weeks of life increases the risk for severe retinopathy of prematurity in extremely preterm infants. Arch Dis Child Fetal Neonatal Ed. 2016;101:F108-13. https://doi.org/10.1136/archdischild-2014-306816
  11. Walsh MC, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179-201. https://doi.org/10.1016/s0031-3955(16)34975-6
  12. Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of respiratory distress syndrome–2019 update. Neonatology. 2019;115:432-50. https://doi.org/10.1159/000499361
  13. Ehrenkranz RA, Walsh-Sukys MC, Vohr BR, et al. New consensus definition of bronchopulmonary dysplasia (BPD-DEF) predicts pulmonary and neurodevelopmental outcomes in early infancy. Pediatr Res. 2001;49:276A.
  14. Gidrewicz DA, Fenton TR. A systematic review and meta-analysis of the nutrient content of preterm and term breast milk. BMC Pediatr. 2014;14:216. https://doi.org/10.1186/1471-2431-14-216
  15. Joosten K, Embleton N, Yan W, Senterre T; ESPGHAN/ESPEN/ESPR/CSPEN working group on pediatric parenteral nutrition. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Energy. Clin Nutr. 2018;37(6):2309-14. https://doi.org/10.1016/j.clnu.2018.06.944
  16. Ahuja AA, V Reddy YC, Adenuga OO, Kewlani D, Ravindran M, Ramakrishnan R. Risk factors for retinopathy of prematurity in a district in South India: A prospective cohort study. Oman J Ophthalmol. 2018;11:33. https://doi.org/10.4103/ojo.ojo_97_2016
  17. Koç E, Baş AY, Özdek Ş, et al. Türkiye Prematüre Retinopatisi Rehberi 2016. Available at: https://www.medikalakademi.com.tr/wp-content/uploads/2020/07/turkiye-premature-retinopatisi-rehberi-2016.pdf
  18. Qiu X, Lodha A, Shah PS, et al. Neonatal outcomes of small for gestational age preterm infants in Canada. Am J Perinatol. 2012;29:87-94. https://doi.org/10.1055/s-0031-1295647
  19. Manzoni P, Stolfi I, Pedicino R, et al. Human milk feeding prevents retinopathy of prematurity (ROP) in preterm VLBW neonates. Early Hum Dev. 2013;89 Suppl 1:S64-8. https://doi.org/10.1016/S0378-3782(13)70019-7
  20. Coşkun Y, Dalkan C, Yabaş Ö, et al. A predictive score for retinopathy of prematurity by using clinical risk factors and serum insulin-like growth factor-1 levels. Int J Ophthalmol. 2017;10:1722-7. https://doi.org/10.18240/ijo.2017.11.14
  21. Heller CD, O'Shea M, Yao Q, et al. Human milk intake and retinopathy of prematurity in extremely low birth weight infants. Pediatrics. 2007;120:1-9. https://doi.org/10.1542/peds.2006-1465
  22. Kao JS, Dawson JD, Murray JC, et al. Possible roles of bilirubin and breast milk in protection against retinopathy of prematurity. Acta Paediatr. 2011;100:347-51. https://doi.org/10.1111/j.1651-2227.2010.02069.x
  23. Ledo A, Arduini A, Asensi MA, et al. Human milk enhances antioxidant defenses against hydroxyl radical aggression in preterm infants. Am J Clin Nutr. 2009;89:210-5. https://doi.org/10.3945/ajcn.2008.26845
  24. Li Y, Yan C, Yang L, Han Z. Effect of breastfeeding versus formula milk feeding on preterm infants in the neonatal intensive care unit. Zhongguo Dang Dai Er Ke Za Zhi. 2017;19:572-5. https://doi.org/10.7499/j.issn.1008-8830.2017.05.019
  25. Fang JL, Sorita A, Carey WA, Colby CE, Murad MH, Alahdab F. Interventions to prevent retinopathy of prematurity: a meta-analysis. Pediatrics. 2016;137:e20153387. https://doi.org/10.1542/peds.2015-3387
  26. Maayan-Metzger A, Avivi S, Schushan-Eisen I, Kuint J. Human milk versus formula feeding among preterm infants: short-term outcomes. Am J Perinatol. 2012;29:121-6. https://doi.org/10.1055/s-0031-1295652
  27. Furman L, Taylor G, Minich N, Hack M. The effect of maternal milk on neonatal morbidity of very low-birth-weight infants. Arch Pediatr Adolesc Med. 2003;157:66-71. https://doi.org/10.1001/archpedi.157.1.66
  28. Bilgen H, Kültürsay N, Türkyılmaz C. Turkish Neonatal Society guideline on nutrition of the healthy term newborn. Turk Pediatri Ars. 2018;53(Suppl 1):S128-37. https://doi.org/10.5152/TurkPediatriArs.2018.01813
  29. Cleminson JS, Zalewski SP, Embleton ND. Nutrition in the preterm infant: what’s new? Curr Opin Clin Nutr Metab Care. 2016;19(3):220-225. https://doi.org/10.1097/MCO.0000000000000270
  30. Can E, Bülbül A, Uslu S, Cömert S, Bolat F, Nuhoğlu A. Effects of aggressive parenteral nutrition on growth and clinical outcome in preterm infants. Pediatr Int. 2012;54:869-74. https://doi.org/10.1111/j.1442-200X.2012.03713.x
  31. Beken S, Dilli D, Fettah ND, Kabataş EU, Zenciroğlu A, Okumuş N. The influence of fish-oil lipid emulsions on retinopathy of prematurity in very low birth weight infants: a randomized controlled trial. Early Hum Dev. 2014;90:27-31. https://doi.org/10.1016/j.earlhumdev.2013.11.002
  32. Lenhartova N, Matasova K, Lasabova Z, Javorka K, Calkovska A. Impact of early aggressive nutrition on retinal development in premature infants. Physiol Res. 2017;66:S215-26. https://doi.org/10.33549/physiolres.933677
  33. Can E, Bülbül A, Uslu S, Bolat F, Cömert S, Nuhoğlu A. Early aggressive parenteral nutrition induced high insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP3) levels can prevent risk of retinopathy of prematurity. Iran J Pediatr. 2013;23:403-10.