The role of neonatal sepsis in the development of retinopathy of prematurity
Authors:   Pirogov Russian National Research Medical University, Moscow, Russian Federation, Nikolaeva G.V. 
Published: February 2025

PurposeTo evaluate relationship between neonatal sepsis and the development of retinopathy of prematurity.

Material and methods. During 2005–2021, a prospective cohort study of the incidence of 642 extremely premature newborns born before 30 weeks of gestation weighing up to 1500 grams (27.7±2 weeks; 1045±256 grams) was conducted in the intensive care unit of the second stage of nursing of the Perinatal Center. Retrospectively, in the period from 2020 to 2023, an analysis of the case histories of 150 premature infants with a gestational age at birth of up to 35 weeks (28.7±1.8 weeks) and a birth weight of up to 2000 grams (1250±339 grams) was carried out. The results of ophthalmological screening and monitoring, analysis of somatic and neurological burden were taken into account. Based on the results of ophthalmological monitoring, the children were divided into 3 groups: without the development of ROP, with the course of ROP according to type I, requiring the surgical stage of treatment, and with the course of ROP according to type II and spontaneous regression.

Results. Analysis showed a high somatic and neurological burden of very premature newborns in the intensive care unit. The development of ROP of any type in very premature children is associated with a high frequency of detection of neonatal sepsis, hypoxic-ischemic damage to the central nervous system, morphological hypoxic disorders of the central nervous system (intraventricular hemorrhages (IVH), periventricular leukomalacia (PVL)), the formation of bronchopulmonary dysplasia (BPD), the presence of a hemodynamically significant functioning arterial duct (HSFA). But against the background of neonatal sepsis, IVH, PVL, BPD, HSFA, retinopathy of prematurity significantly more often proceeded in a severe form and required a surgical stage of treatment. Retrospective analysis of case histories of more mature premature infants born before 35 weeks of gestation with a weight of up to 2000 grams did not reveal a significant difference in the frequency of detection of cerebral ischemia of the 2–3rd degree, IVH, PVL in groups with the development of ROP type I and II (p>0.05). In children at risk of developing retinopathy of prematurity, these nosologies were associated with the development of any retinopathy of prematurity, did not affect the severity of the disease. The development of ROP of any type in deeply premature infants treated in the intensive care unit of the 2nd stage of nursing is associated with a high frequency of detection of neonatal sepsis.

Neonatal sepsis was absent in the group without ROP, but in 52% of cases, it was detected more than 2 times more often in children with ROP type I compared to the group with ROP type II (18.8%, p<0.05). The same pattern was observed in more mature premature infants examined at the second stage of the study. Neonatal sepsis was highly associated with the development of ROP type I (p=0.000092). The absence of neonatal sepsis significantly reduced the risk of developing severe ROP. Conclusion. Development of retinopathy of prematurity and its severe course are associated with a high incidence of neonatal sepsis, hypoxic-ischemic CNS damage with morphological abnormalities (intraventricular hemorrhage, periventricular leukomalacia), bronchopulmonary dysplasia, and hemodynamically significant arterial duct. Neonatal sepsis is statistically significantly associated with severe ROP, is a factor independent of the child’s maturity and can be used to predict the development and course of ROP.

Key words: premature infants, retinopathy of prematurity, pathogenesis, risk factors, neonatal sepsis, periventricular leukomalacia, intraventricular hemorrhage, bronchopulmonary dysplasia.