Insulin, Hyperglycemia, and Severe Retinopathy of Prematurity in Extremely Low-Birth-Weight Infants

Abstract

Objective This study aims to determine the association between hyperglycemia, insulin therapy, and severe retinopathy of prematurity (ROP) in extremely low-birth-weight (ELBW) infants. Study Design In this retrospective database study, we included all ELBW infants who were 180 mg/dL. Covariates were GA, small for GA status, discharge year, sex, Apgar score at 5 minutes, mechanical ventilation, oxygen use, bacteremia, and postnatal steroid exposure. We defined severe ROP as ROP requiring bevacizumab, cryotherapy, laser therapy, or vitrectomy. Sensitivity analysis using BG > 150 mg/dL and > 200 mg/dL was performed. Results A total of 24,548 infants were included; 2,547 (10%) had severe ROP. Hyperglycemia alone was not associated with severe ROP (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.66-1.17). Hyperglycemia and insulin use were not associated with severe ROP (OR, 1.43; 95% CI, 0.91-2.23). BG > 150 mg/dL and insulin use were associated with severe ROP (OR, 1.34; 95% CI, 1.02-1.76). Conclusions Hyperglycemia alone was not associated with severe ROP in ELBW infants. However, we did observe a possible trend between the use of insulin and severe ROP. ; National Center for Advancing Translational Sciences of the National Institutes of Health (NIH) ; U.S. government ; National Institute of Child Health and Human Development ; NIH ; National Center for Advancing Translational Sciences of the NIH ; U.S. Food and Drug Administration ; Cempra Pharmaceuticals ; Duke Univ, Dept Pediat, Sch Med, Durham, NC 27706 USA ; Duke Univ, Sch Med, Duke Clin Res Inst, Durham, NC USA ; KK Womens & Childrens Hosp, Childrens Intens Care Unit, Singapore, Singapore ; Univ Fed Sao Paulo, Ecola Paulista Med, Div Neonatal Med, Sao Paulo, Brazil ; Univ N Carolina, Dept Pediat, Chapel Hill, NC USA ; MEDNAX Inc, Pediat Med Grp, Jacksonville, FL USA ; Univ Fed Sao Paulo, Ecola Paulista Med, Div Neonatal Med, Sao Paulo, Brazil ; NIH: UL1TR001117 ; U.S. government: HHSN267200700051C ; National Institute of Child Health and Human Development: K23HD068497 ; National Institute of Child Health and Human Development: HHSN275201000003I ; National Institute of Child Health and Human Development: 1R01-HD081044-01 ; National Center for Advancing Translational Sciences of the NIH: UL1TR001117 ; U.S. Food and Drug Administration: 1R18-FD005292-01 ; Cempra Pharmaceuticals: HHS0100201300009C ; Web of Science