The influence of early postnatal nutrition on retinopathy of prematurity in extremely low birth weight infants☆

Abstract 

Background

Retinopathy of prematurity(ROP) is the most common serious ophthalmic disease in preterm infants. Human milk may provide a protective effect for ROP; however, beneficial effects of human milk preclude randomized trials. Therefore, we conducted a retrospective analysis comparing early postnatal nutrition with ROP development.

Objective

Evaluate relationship between early postnatal nutriture and ROP surgery.

Design/methods

Nutrition data was collected for inborn AGA infants, BW 700–1000g. ROP surgery was the primary outcome variable. A single pediatric ophthalmologist supervised examinations. All infants received triweekly IM vitamin A as chronic lung disease prophylaxis (Tyson: NEJM, 1999).

Results

BW and gestational age were 867±85g and 26.3±1.2weeks (n=77, mean±1SD). ROP surgery infants(n=11) received more parenteral nutrition, 1648mL, and less human milk, 13.8mL/kg-day, and vitamin E, 1.4mg/kg-day, during the second postnatal week. Human milk was a negative predictor for ROP surgery, odds ratio=0.94. Both groups met vitamin A recommendations; however, 74% was administered via IM injections. Neither group met vitamin E recommendations.

Conclusions

Human milk feeding, parenteral nutrition volume and vitamin E intake were predictors for ROP surgery. IM vitamin A injections provided the majority of vitamin A; vitamin E administration was insufficient. Improving human milk feeding rates and vitamin dosing options may affect ROP surgery rates.

Keywords: Preterm infant, Enteral nutrition, Parenteral nutrition, Vitamin, Retinopathy of prematurity, Human milk

Abbreviations: ROP, retinopathy of prematurity, ELBW, extremely low birth weight (birth weight<1000g, about 2lb, 3oz), VLBW, very low birth weight (birth weight<1500g, about 3lb, 5oz), CRYO, cryosurgery