Pulmonary hypertension, inhaled nitric oxide, and retinopathy of prematurity: evidence from the U.S. national database.

BACKGROUND

The study aimed to examine the association of pulmonary hypertension (PH) and the use of inhaled nitric oxide (iNO) with retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants.

METHODS

Utilizing the United States National Inpatient Sample (NIS) database, VLBW infants were identified. Chi-square and Fisher's exact tests were used to calculate unadjusted odds ratios (ORs) for the presence of ROP in relation to PH and iNO therapy. Adjusted odds ratios (aORs) were calculated using logistic regression while controlling for potential confounders.

RESULTS

Among 1,007,141 infants, 30,401 (3%) had PH. ROP was diagnosed more frequently with PH (22.3% vs 13.6%; aOR: 1.32, 95% CI: 1.28-1.36, p < 0.001). Severe ROP was less frequent in iNO-treated PH infants (4.33% vs 5.35%; aOR: 0.82, 95% CI: 0.70-0.96, p = 0.02). In extremely low birth weight (ELBW) infants with PH, iNO use was associated with lower rates of severe ROP (aOR: 0.68, 95% CI: 0.57-0.81, p < 0.001).

CONCLUSIONS

PH is associated with an increased risk of ROP. iNO therapy is associated with a decreased prevalence of severe ROP in PH-affected infants. Further studies are needed to assess the early use of vascular modulators in mitigating the risk for ROP.

IMPACT: Premature infants diagnosed with pulmonary hypertension are at increased risk for ROP. Severe ROP is less encountered when inhaled nitric oxide was used in this vulnerable population. This is the first study to assess the interaction between pulmonary hypertension, its treatment, and the development of ROP in premature infants. The study suggests the need for future studies to assess the efficacy of early use of vascular modulators in mitigating the risk of ROP.