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Low Birth Infants Treated With Steroids May Have Vision Problems

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Considering the effects of corticosteroids on lung function, mainly in infants who are ventilator based, corticosteroids are, at times, administered to very low birth weight neonates to treat evolving lung disease. However, it has long been been suspected that steroids could have negative neurodevelopmental effects on very premature babies.

In a study published in the Journal of the American Association for Pediatric Ophthalmology and Strabismus (AAPOS), researchers have found out that for very premature infants with birth weights of less than 500 grams, there was a 1.6 time increased chance for retinopathy of prematurity (ROP) and a 1.7 times greater danger for advanced ROP.

Data on 1,472 neonates discharged from 167 Neonatal Intensive Care Units between 1996 and 2013 had been gathered from the Pediatrix BabySteps Clinical Data Warehouse, a large scale database of infant wellness records. Even though this database comprises information on more than 1.1 million infants, investigators confined their evaluation to extremely premature infants, with birth weights at the lower level of viability.

These special infants have the greatest threat for disorders associated with prematurity. Neonates within the study met three predominant standards: birth weight of less than 500 grams, discharged from the hospital alive, and availability of ophthalmic ROP examination results. Diagnoses of ROP had been standardized according to the International Classification of Retinopathy of Prematurity.

Lead investigator Tammy Z. Movsas, MD, MPH, Medical Director, Midland County Department. of Public Health, Midland, MI and Clinical Associate Professor of Pediatrics and Human Development, Michigan State University, School of Human Medicine, Our study group consists of premature infants with birthweights at the lowest level that is compatible with life. This group represents a more homogeneous set of neonates than in other studies that consist of premature infants with a broader range of birthweights. Neonates at these critically low birth weights (and gestational ages) are at the absolute highest vulnerability for a host of neonatal morbidities including ROP and bronchopulmonary dysplasia. Thus, clinical differences between steroid treated and untreated neonates are minimized.

These results indicated that after correcting for lung ailments as well as different reasons that may make a contribution to ROP risk corresponding to gestational age, there may be still a higher risk of ROP in steroid-handled infants than in those infants not handled with steroids. 1,059 (72%) of the babies got postnatal steroids while 413 (28%) didn’t.

The total incidence of ROP (of any stage) for the entire group was once 76.6%, and the overall incidence of advanced stage ROP (phases 3, 4, or 5) used to be 31.3%. The incidence of any ROP was once enormously better in steroid-treated toddlers (80.5%) than in non-treated infants (66.8%). For advanced stage ROP, incidence was also tremendously higher within the treated group (35.3%) compared to the untreated group (21.1%).

The lead author commented, This study of a large database of critically low birth weight survivors indicates that steroid-treated infants have a modest but significantly increased risk for ROP. That said, clinicians need to use their best judgment to balance the positive effects from steroids on developing lungs with potential negative effects on developing eyes in very premature infants. This study has potential clinical significance since children with a history of ROP are not only at increased risk for visual impairments from the ROP itself, but are also at increased risk for developing other ocular disorders later in life.

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