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

ABSTRACT

To evaluate early aggressive vs. conservative nutrition and its effect on Retinopathy of Prematurity [ROP] in <32 weeks of gestation neonates. A prospective, randomized, clinical study was conducted in NICU with a total of 75 preterm infants. In the intervention group, infants received early aggressive nutrition immediately after birth, in the control group infants were started on conventional parenteral nutrition [PN]. Blood samples were obtained for Insulin-like growth factor 1 [IGF-1] and insulin-like growth factor binding protein 3 [IGFBP3] levels before commencement of PN on the first postnatal day, and from week 1 to 6 every week. All the infants were examined for ROP. Infants in the early aggressive group had a reduction in the risk of ROP of 5% [2 from 40]; the number of infants needed treatment averaged 3.7 [2.7 to 5.2]. A total of 11 neonates in the conventional group were detected having ROP [P<0.05]. Overall, IGF-I levels were higher in the aggressive PN [APN] vs the conventional PN [CPN]. ROP development was higher in the CPN compared to the APN. IGF-1levels were lower in ROP developers compared with non-ROP in the APN group. There was no difference in IGF-I levels in ROP developers versus non-ROP in the CPN group. IGF-1 levels were lower in the CPN group compared with the APN group in the third week in ROP developers. There was a correlation between ROP and IGF-1 levels. Through ROC analysis, IGF-1 was demonstrated as being a sensitive marker for ROP. IGF-1 levels were higher in the APN group versus the CPN group. This may indicate that IGF-1 levels simply being higher is not enough; rather, that being higher above a cutoff value may prevent ROP