Recurrent culture-proven sepsis linked to retinopathy of prematurity in neonates: JAMA

A new study published in the Journal of American Medical Association suggests that repeated culture-proven sepsis should be recognized as a modifiable risk factor linked to retinopathy of prematurity in extremely preterm newborns.

Retinopathy of prematurity (ROP) is a significant morbidity associated with preterm newborns that results in visual impairment, including blindness. Prevention and prompt treatment are essential to combat this condition. There is mounting evidence that the development of ROP is facilitated by exposure to neonatal sepsis. In order to better understand the relationship between neonatal sepsis and ROP in two sizable cohorts of preterm children born at fewer than 29 weeks of gestation, Kirsten Glaser and colleagues undertook this study.

The data from the Norwegian Neonatal Network (NNN) and German Neonatal Network (GNN) were utilized in this retrospective cohort analysis. There were 68 level III neonatal critical care units in the GNN and 21 in the NNN. The newborns for this research were recruited in the GNN between January 1, 2009 and December 31, 2022, and the NNN between January 1, 2009 and December 31, 2018. They ranged in gestation from 22 weeks and 0 days to 28 weeks and 6 days. From February through September of 2023, the data obtained were examined. 

This study included the mean (SD) birth weight of the 12,794 newborns in the GNN were 848 (229) g and the 1844 infants included in the NNN were 807 (215) g. 6370 newborns (49.8%) in GNN and 620 infants (33.6%) in NNN had any ROP, whereas 840 infants (6.6%) in GNN and 140 infants (7.6%) in NNN had treatment-warranted ROP.

With every incident of sepsis in both groups, the incidence of treatment-warranted ROP increased. Following the GNN multiple confounders' adjustment of this dataset, the number of sepsis episodes was linked to both ROP and treatment-warranted ROP when compared to 0 episodes. Propensity score matching verified these connections for any ROP. Also, the surgical NEC was linked to treatment-warranted ROP in the NNN dataset.

The outcome of this large-scale cohort analysis found that in preterm children delivered at fewer than 29 weeks, ROP and treatment-warranted ROP were particularly linked with culture-proven neonatal sepsis and recurrent sepsis episodes. It is important to do more research to determine the underlying processes of any inflammation-driven retinal morbidity and to determine if this connection is causative

Reference:

Glaser, K., Härtel, C., Klingenberg, C., Herting, E., Fortmann, M. I., Speer, C. P., Stensvold, H. J., Huncikova, Z., Rønnestad, A. E., Nentwich, M. M., Stahl, A., Dammann, O., Göpel, W., Faust, K., Müller, D., Thome, U., Guthmann, F., von der Wense, A., … Wieg, C. (2024). Neonatal Sepsis Episodes and Retinopathy of Prematurity in Very Preterm Infants. In JAMA Network Open (Vol. 7, Issue 7, p. e2423933). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.23933