Genetic and Environmental Influences on Retinopathy of Prematurity.

OBJECTIVE: The goals were to isolate and study the genetic susceptibility to retinopathy of prematurity (ROP), as well as the gene-environment interaction established in this disease. METHODS: A retrospective study (2000-2014) was performed about the heritability of retinopathy of prematurity in 257 infants who were born at a gestational age of ≤ 32 weeks. The ROP was studied and treated by a single pediatric ophthalmologist. A binary logistic regression analysis was completed between the presence or absence of ROP and the predictor variables. RESULTS: Data obtained from 38 monozygotic twins, 66 dizygotic twins, and 153 of simple birth were analyzed. The clinical features of the cohorts of monozygotic and dizygotic twins were not significantly different. Genetic factors represented 72.8% of the variability in the stage of ROP, environmental factors 23.08%, and random factors 4.12%. The environmental variables representing the highest risk of ROP were the number of days of tracheal intubation (p < 0.001), postnatal weight gain (p = 0.001), and development of sepsis (p = 0.0014). CONCLUSION: The heritability of ROP was found to be 0.73. The environmental factors regulate and modify the expression of the genetic code.

[Retinopathy of prematurity in multiple births: risk analysis for plus disease]. / Enfermedad plus en la retinopatía del prematuro de gestación múltiple. Análisis de riesgo.

PURPOSE: To analyze the risk factors associated with plus disease in retinopathy of prematurity (ROP). METHOD: Over a period of 8.5 years we carried out a prospective study of ROP in twins and triplets. Fifty-four multiple-birth infants with low birth weight (< or =1500 g) and low gestational age (32< or = weeks) were admitted to the University Hospital of Granada. RESULTS: Logistic regression analyses showed the following variables to be associated with an increased risk of plus disease: severe ROP, large area of avascular retina, low gestational age, low birth weight, a patent ductus arteriosus, length of mechanical ventilation, adverse events increase, low 5 min Apgar scores and poor postnatal weight gain (in the first 4 to 6 weeks of life). Using multiple logistic regression, only the grade of ROP (OR: 5.5; p < 0.009) and poor postnatal weight gain (OR: 0.58; p < 0.04) were predictive factors of development of plus disease. Infants with <> disease gained an average 3.9 +/- 3.1 g/day in the first 6 weeks of life, compared to a mean of 11.84 +/- 8.3 g/day for those without plus disease (p < 0.0001). CONCLUSION: Advanced ROP stages and poor weight gain were the most significant factors associated with plus disease. Twins who gained weight at more than 7 g/day in the first 4-6 weeks of life had a significantly reduced risk of plus disease. A good weight gain is an effective strategy against avoidable blindness due to ROP.

Enfermedad plus en la retinopatía del prematuro de gestación múltiple. Análisis de riesgo / Retinopathy of prematurity in multiple births: risk analysis for plus disease

Objetivo: Determinar los factores de riesgo asociadoscon la enfermedad plus en la retinopatía delprematuro (ROP).Método: En los últimos 8,5 años, realizamos unestudio prospectivo sobre la ROP en gemelos y trillizos.Cincuenticuatro prematuros nacidos de partomúltiple con peso (≤ 1500 gr) y edad gestacional(≤ 32 semanas).Resultados: Los factores que presentaron asociadoun mayor riesgo de enfermedad plus fueron: gradoavanzado de ROP, mayor área sin vascularizar,menor edad gestacional, menor peso al nacer, existenciade ductus arteriovenoso persistente, mayornúmero de días intubado, mayor número de eventosadversos, menor puntaje en el test Apgar 2 y unamenor ganancia de peso postnatal. Con regresiónlogística binaria, sólo el grado más avanzado deROP (OR: 5,5; p < 0,009) y la menor ganancia depeso posnatal (OR: 0,58; p < 0,04) resultaron factorespredictivos del desarrollo de la enfermedad plus.En las 4-6 primeras semanas de vida, los niños conenfermedad plus obtenían una pobre gananciamedia de peso de 3,9 ± 3,1 gr/día frente a los11,84 ± 8,3 gr/día que alcanzaban aquellos sinenfermedad plus (p < 0,0001).Conclusiones: Los factores más significativamenteasociados con la enfermedad plus eran el estadioavanzado de ROP y la pobre ganancia de peso. Losgemelos que ganan más de 7 gr/día de peso, en lasprimeras 4-6 semanas de vida, significativamentereducen el riesgo de enfermedad plus. Una buenaganancia de peso postnatal es una estrategia efectivacontra la ceguera evitable de la ROP(AU)

Purpose: To analyze the risk factors associated withplus disease in retinopathy of prematurity (ROP).Method: Over a period of 8.5 years we carried outa prospective study of ROP in twins and triplets.Fifty-four multiple-birth infants with low birthweight (≤ 1500 g) and low gestational age (32≤weeks) were admitted to the University Hospital ofGranada.Results: Logistic regression analyses showed thefollowing variables to be associated with an increasedrisk of plus disease: severe ROP, large area ofavascular retina, low gestational age, low birthweight, a patent ductus arteriosus, length of mechanicalventilation, adverse events increase, low 5 minApgar scores and poor postnatal weight gain (in thefirst 4 to 6 weeks of life).Using multiple logistic regression, only the grade ofROP (OR: 5.5; p < 0.009) and poor postnatal weightgain (OR: 0.58; p < 0.04) were predictive factors ofdevelopment of plus disease. Infants with ®plus»disease gained an average 3.9 ± 3.1 g/day in the first6 weeks of life, compared to a mean of 11.84 ± 8.3g/day for those without plus disease (p < 0.0001).Conclusion: Advanced ROP stages and poorweight gain were the most significant factors associated with plus disease. Twins who gained weightat more than 7 g/day in the first 4-6 weeks of lifehad a significantly reduced risk of plus disease. Agood weight gain is an effective strategy againstavoidable blindness due to ROP(AU)