Association of Postnatal Dexamethasone Use and Fungal Sepsis in the Development of Severe Retinopathy of Prematurity and Progression to Laser Therapy in Extremely Low-Birth-Weight Infants

Abstract

The objective of this study was to evaluate the role of postnatal dexamethasone use and fungal sepsis in the development of severe retinopathy and progression to laser therapy. Postnatal steroids have been frequently used in the management of infants with chronic lung disease, airway edema, and hypotension, but their use is not free from adverse effects. Postnatal dexamethasone use has been associated with increased risk for the development of fungal sepsis, but the influence of glucocorticoid therapy on retinopathy of prematurity (ROP) is controversial. Candida sepsis has been shown to be associated with severe ROP and the need for laser therapy in some studies but not in others. Medical records of all or =3) 52% (68). Severe ROP was more frequent in Caucasian infants (p=0.005) and in infants who received postnatal dexamethasone (p< or =0.0001). The development of threshold ROP (zone 1 or 2 with stage 3+, five contiguous or eight total clock hours of the retina) and requirement for laser therapy were higher in Caucasians (p=0.0002) and in infants with fungal sepsis (p=0.001). Antenatal steroids had no effect on the severity of ROP or the need for laser treatment. Postnatal dexamethasone use was significantly associated with fungal sepsis 13/14 (93%). After controlling for gestational age, race, days on supplemental oxygen, and fungal sepsis, cumulative postnatal dexamethasone use was independently associated with severe ROP [OR 1.2 (1.04-1.33)], and fungal sepsis [OR 8.2 (2.0-33.0)] was independently associated with the need for laser therapy. Postnatal steroid use is an independent risk factor for development of severe ROP. The risk of threshold ROP requiring laser treatment was higher in infants who developed fungal sepsis.