Association between antenatal and postnatal steroids and retinopathy of prematurity.

BACKGROUND

Steroid treatment can be crucial in treating morbidity and reducing mortality in preterm infants. The literature describes differing effects of antenatal (ANS) versus postnatal steroids (PNS) in the development of retinopathy of prematurity (ROP). The purpose of this study was to investigate the relationship between steroid use and development of ROP in Canadian neonates.

METHODS

Data were obtained from the Canadian Neonatal Network (CNN), a national database of all 32 level III neonatal intensive care units (NICUs) in Canada. A total of 20,255 neonates met inclusion criteria, with admission to a CNN NICU under the gestational age of 31 weeks or <1,250 g, with ROP screening. Unadjusted and adjusted odds ratios based on confounders from conditional logistic regression were determined for the risk of developing any ROP, type 1 ROP, and non-type 1 ROP, depending on ANS and PNS use.

RESULTS

Using ANS only as the reference group, neonates receiving only PNS had the highest odds of type 1 ROP and ROP requiring intervention (adjusted OR = 2.68; 95% CI, 1.55-4.64), followed by neonates receiving both ANS and PNS with an adjusted odds ratio of 2.51 (95% CI, 1.49-4.25).

CONCLUSIONS

Receipt of PNS was associated with type 1 or treated ROP, suggesting the need for closer monitoring for ROP; however, confounding by indication bias cannot be ruled out.