ObjectiveTo investigate the clinical risk factors of preterm infants and its severity in premature infants with bronchopulmonary dysplasia (BPD) with retinopathy of prematurity (ROP).MethodsRetrospective clinical study was performed. A total of 126 preterm infants with BPD in the Neonatal Department of the Affiliated Hospital of Qingdao University from January 2016 to December 2018 were enrolled in the study. Among them, 69 were males and 57 were females, whose gestational age＜32 weeks and birth weight＜1500 g. BPD grades Ⅰ, Ⅱ, and Ⅲ were 63, 40, and 23 cases respectively. According to the presence or absence of ROP, children were divided into ROP group and non-ROP group, with 48 (38.1%) and 78 (61.9%) cases respectively. The differences of clinical data between the two groups were compared and analyzed. Quantitative data comparison between groups was performed by t test, and count data comparison was performed by χ2 test. The risk factors of ROP in BPD premature infants were analyzed by multi-factor logistics regression. The correlation between BPD severity and ROP severity was tested by Spearman rank correlation test.ResultsCompared with the non-ROP group, the ROP group had a smaller gestational age (t=5.988), lower birth weight (t=7.371), higher the application rate of oxygen concentration＞30% (duration of service＞24 h), high rate (χ2=17.244) and longer noninvasive ventilation time (t=－7.139), the differences were statistically significant (P＜0.05). In the logistic regression model, the noninvasive ventilation time was the risk factor for ROP in preterm infants with BPD (OR≈1.054, P＜0.05), while gestational age and birth weight were importantly protective factors for ROP in preterm infants with BPD (OR≈0.938, 0.996; P＜0.05). The results of the correlation analysis found that the severity of BPD was significantly positively correlated with the severity of ROP. As the severity of BPD increased, the severity of ROP increased, and the difference was statistically significant (rs=0.306, P＜0.035).ConclusionsFetal gestational age, low birth weight, hyperoxia, and long-term non-invasive mechanical ventilation are the main risk factors for ROP in preterm infants with BPD. The severity of BPD is positively correlated with the incidence and severity of ROP.
ObjectiveTo investigate the relationship between peripheral blood inflammatory markers and the development of retinopathy of prematurity (ROP) in extremely low birth weight infants (ELBWI), and to preliminarily evaluate their predictive value for ROP. MethodsA retrospective clinical study. A total of 191 ELBWI who were born at The Affiliated Hospital of Qingdao University and admitted to the neonatal intensive care unit between January 2018 and December 2023 were enrolled. According to the presence or absence of inflammation-related diseases (necrotizing enterocolitis, bronchopulmonary dysplasia, neonatal sepsis), infants were divided into an inflammation-related disease group (144 cases) and a non-inflammation-related disease group (47 cases). Clinical data and peripheral blood inflammatory markers at 7, 14, and 28 days after birth, including white blood cell count (WBC), C-reactive protein (CRP) level, neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) that were compared between the two groups, as well as between infants with and without ROP within the inflammation-related disease group. Logistic regression analysis was used to identify variables associated with the occurrence of ROP. A receiver operating characteristic (ROC) curve was constructed to assess the predictive performance of the combined model, and decision curve analysis (DCA) was applied to evaluate its potential clinical utility. ResultsAmong the 191 infants included, 80 cases were diagnosed with ROP (41.9%, 80/191). The incidence of ROP was 68/144 (47.22%) in the inflammation-related disease group and 12/47 (25.53%) in the non-inflammation-related disease group, with a statistically significant difference between the two groups (χ2=6.849, P=0.010). In the inflammation-related disease group, compared with infants without ROP, those with ROP had lower birth weight (Z=?2.591) and gestational age (Z=?2.942), a lower proportion of cesarean delivery (χ2=5.846), longer durations of invasive and noninvasive mechanical ventilation (Z=?2.500, ?2.057), and a higher incidence of patent ductus arteriosus (χ2=4.598) (P＜0.05). Levels of inflammatory markers were significantly higher in the ROP group, including WBC and SII at 7 days (Z=?2.85, ?2.565), SII at 14 days (Z=?2.531), and WBC, NLR, and SII at 28 days after birth (Z=?2.385, ?3.051, ?2.719; P＜0.05). In contrast, CRP levels at 7, 14, and 28 days did not differ significantly between ROP and non-ROP infants (Z=?1.550, ?0.796, ?0.132; P＞0.05). Multivariate logistic regression analysis showed that decreased birth weight [95% confidence interval (CI) 0.990-0.998] and increased WBC at 7 days (95%CI 1.004-1.129) and SII at 28 days (95%CI 1.001-1.006) after birth were independent related factors for the occurrence of ROP (P＜0.05). ROC curve analysis indicated that the area under the curve for predicting ROP by combining birth weight, WBC at 7 days after birth, and SII at 28 days was 0.71, with a sensitivity of 91% and a specificity of 44%. DCA shows that when the risk threshold is 31% to 98%, this combined prediction model has a positive net clinical benefit. In the non-inflammation-related disease group, only birth weight was negatively correlated with the occurrence of ROP (95%CI 0.975-0.996, P=0.005). ConclusionsIn ELBWI patients with inflammation-related diseases, the levels of peripheral blood WBC and SII are associated with the occurrence of ROP. The combination of birth weight and inflammatory indicators at specific time points has certain predictive value for ROP.