Retinopathy of Prematurity Requiring Treatment Linked With Head Growth Failure

Premature Baby Retinopathy
Retinopathy In Premature Infant. Retinal Fluorescein Angiogram Showing Hypoxia Of The Retinal Periphery. Recolorized, Black And White Image. (Photo By BSIP/UIG Via Getty Images)
While head circumference growth was linked with more severe retinal disease, weight and length were not.

Retinopathy of prematurity (ROP) that requires treatment is fundamentally related with poor head growth during care in the neonatal intensive care unit (NICU), according to a report published in Neonatology. These findings may suggest that head circumference can foretell the need for a patient to undergo a procedure related to ROP.

Data for this study were sourced from the Korean Neonatal Network (KNN) database which has collected information from very low birth weight (VLBW) infants (<1500 g) since 2013. Infants (N=3133) born between 2013 and 2017 were propensity matched in a 1:1 ratio among those requiring ROP treatment (n=472) and not requiring treatment (n=472) to compare prenatal growth factors. Growth failure was defined as the change in anthropometric z-score between birth and NICU discharge lower than the tenth percentile.

Among the entire cohort, the ROP treated (n=624) and not treated (n=2509) cohorts were born at an average gestational age of 26.00±1.25 and 27.37±1.17 weeks (P <.001), birth weight was 833.12±193.55 and 1019.4±207.16 g (P <.001), 35.9% and 29.8% were born from a multiple pregnancy (P =.003), and 26.8% and 21.8% were fertilized by in vitro fertilization (IVF; P =.008), respectively.

Among the entire ROP treated cohort, 59.0% received laser photocoagulation, 18.1% anti-vascular endothelial growth factor (anti-VEGF) therapy, and 16.2% received both laser photocoagulation and anti-VEGF therapy.

Z-score changes at birth, discharge, and the change between birth and discharge were significantly lower for weight, length, and head circumference among the cohort of children requiring ROP treatment (all P <.001). Among the propensity matched group, all z-scores remained significantly lower for the cohort requiring ROP treatment (all P ≤.047), except for length at birth (mean, −0.43 vs −0.33; P =.114).

In the univariate analysis, postnatal growth failure of weight was associated with ROP requiring treatment (odds ratio [OR], 1.58; P =.011), z-score at birth (OR, 1.40; P =.023), duration of hospitalization (OR, 1.02; P =.001), and duration of invasive ventilation (OR, 1.01; P =.011).

Postnatal growth failure in length associated with IVF (OR, 2.38; P =.009), maternal hypertension (OR, 2.07; P =.037), duration of invasive ventilation (OR, 1.03; P <.001), duration of hospitalization (OR, 1.02; P <.001), and days to achieve 100 mL/kg/day of enteral feeding (OR, 1.01; P =.017).

Predictors of failure for head growth included ROP requiring treatment (OR, 2.11; P <.001), male sex (OR, 2.07; P =.021), z-score at birth (OR, 1.46; P =.015), duration of invasive ventilation (OR, 1.03; P <.001), days to achieve 100 mL/kg/day of enteral feeding (OR, 1.02; P =.007), and duration of hospitalization (OR, 1.02; P =.010).

In the multivariate model, ROP requiring treatment remained significantly associated with head circumference postnatal growth failure (adjusted OR, 1.91; 95% CI, 1.18-3.09; P =.008).

This study may have been limited by its definition of growth failure which was defined as such due to the difference in magnitude between INTERGROWTH-21st standard, used to measure study participants, and the Fenton chart.

This study found that VLBW infants requiring treatment for ROP were associated with poor postnatal head circumference growth.


Bae SP, Kim E-K, Yun J, Yoon YM, Shin SH, Park SY. Retinopathy of prematurity requiring treatment is closely related to head growth during neonatal intensive care unit hospitalization in very low birth weight infants. Neonatology. 2022;119(2):176-183. doi:10.1159/000519714