Session: Neonatal General 13: Retinopathy of Prematurity
453 - Relationship Between Intracranial Hemorrhage and Retinopathy of Prematurity Among Extremely Preterm Infants
Monday, April 28, 2025
7:00am – 9:15am HST
Publication Number: 453.6270
Marwa M. Elgendy, University of Florida, Jacksonville, FL, United States; Mohammad Adawi, University of Florida College of Medicine, Jacksonville, FL, United States; Doaa El Amrousy, Faculty of Medicine, Tanta University, Egypt, Tanta, Al Gharbiyah, Egypt; Kelly Unkrich, Nemours Children's Specialty Care, Jacksonville, FL, United States; Abdelrahman Mohamed. Elmashad, Faculty of Medicine Tanta University, Tanta, Al Gharbiyah, Egypt; Vasantha HS. Kumar, University of Florida College of Medicine, Jacksonville, Jacksonville, FL, United States; Mark L. Hudak, University of Florida College of Medicine - Jacksonville, Jacksonville, FL, United States; Josef Cortez, UF Health Jacksonville, Jacksonville, FL, United States
University of Florida Jacksonville, Florida, United States
Background: Retinopathy of prematurity (ROP) and intracranial hemorrhage (ICH) present important challenges in preterm infants, potentially leading to blindness and impaired neurodevelopmental outcomes. Preterm infants' susceptibility to ICH and ROP stems from their underdeveloped organ systems, particularly the brain and retina. Contributing factors such as low birth weight, immature blood vessel formation, and exposure to supplemental oxygen further compound these risks. Objective: To evaluate the relationship between the severity of ICH and the development of severe ROP that necessitated management with bevacizumab injections in extremely preterm infants. Design/Methods: We conducted a case-control study (severe ICH, defined as parenchymal hemorrhage or intraventricular hemorrhage with ventricular dilation vs. mild ICH) from a cohort of extremely preterm infants (EPI, < 28 weeks’ gestational age) who were diagnosed with ROP between 2017 and 2023 in the University of Florida – Jacksonville Health Hospital. ROP was classified according to standard criteria based on stage and severity, with or without plus disease. Mild ROP was defined as maximum stages 0, 1, and 2; severe ROP was defined as plus disease or stages 3 or 4, with or without plus disease. Infants with severe ROP received intraocular injection of an anti-vascular endothelial growth factor agent (bevacizumab) and/ or laser therapy. Regression analysis was employed to adjust for potential confounders. Results: 364 EPI were born during the study period; 32 (8.7%) died in the NICU. Among the 332 survivors, 57 infants were diagnosed with ICH, 37 had mild ICH and 20 had severe ICH. Notably, severe ICH was associated with lower GA and BW (Table 1). Ninety percent (18 of 20 infants) with severe ICH compared to 51.4% (19/37) of infants with mild ICH had severe ROP (p < 0.001; Table 1). All infants with severe ROP and severe ICH received intravitreal injection of bevacizumab, whereas only 43% of those with severe ROP and mild ICH were treated with bevacizumab (p=0.001, Table 1). Regression analysis revealed a significant association between severe ICH and severe ROP requiring bevacizumab injection, with an odds ratio of 5.607 (95% CI: 1.561–20.140, p = 0.008, Table 2).
Conclusion(s): In our cohort of preterm infants, we identified that severe ICH is a risk factor for severe ROP independent of gestational age and birth weight. These findings emphasize the necessity for additional prospective studies to validate these associations.
