Effects of Neonatal Hyperglycemia on Retinopathy of Prematurity and Visual Outcomes at 7 Years of Age: A Matched Cohort Study

Myra Leung; Joanna Black; Frank H Bloomfield; Greg D Gamble; Jane E Harding; Yannan Jiang; Tanya Poppe; Benjamin Thompson; Anna C Tottman; Trecia A Wouldes; Jane M Alsweiler; PIANO study group

doi:10.1016/j.jpeds.2020.04.059

Effects of Neonatal Hyperglycemia on Retinopathy of Prematurity and Visual Outcomes at 7 Years of Age: A Matched Cohort Study

J Pediatr. 2020 Aug:223:42-50.e2. doi: 10.1016/j.jpeds.2020.04.059.

Collaborators

PIANO study group:
Janene B Biggs, Coila Bevan, Kelly Fredell, Sabine Huth, Christine Kevan, Geraint Phillips, Jennifer A Rogers, Heather Stewart, Kathryn A Williamson

Affiliations

¹ School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand; Department of Optometry and Vision Science, University of Canberra, Canberra, Australia.
² School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand.
³ Liggins Institute, University of Auckland, Auckland, New Zealand.
⁴ School of Optometry and Vision Science, University of Auckland, Auckland, New Zealand; School of Optometry and Vision Science, University of Waterloo, Ontario, Canada.
⁵ Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand; Newborn Services, National Women's Health, Auckland City Hospital, Auckland, New Zealand.

PMID: 32711750
DOI: 10.1016/j.jpeds.2020.04.059

Abstract

Objective: To determine whether neonatal hyperglycemia is associated with retinopathy of prematurity (ROP), visual outcomes, and ocular growth at 7 years of age.

Study design: Children born preterm (<30 weeks of gestational age) at a tertiary hospital in Auckland, New Zealand, who developed neonatal hyperglycemia (2 blood glucose concentrations ≥153 mg/dL [8.5 mmol/L] 4 hours apart) were matched with children who were not hyperglycemic (matching criteria: sex, gestational age, birth weight, age, socioeconomic status, and multiple birth) and assessed at 7 years of corrected age. The primary outcome, favorable overall visual outcome (visual acuity ≤0.3 logarithm of the minimum angle of resolution, no strabismus, stereoacuity ≤240 arcsec, not requiring spectacles) was compared between groups using generalized matching criteria-adjusted linear regression models.

Results: Assessments were performed on 57 children with neonatal hyperglycemia (hyperglycemia group) and 54 matched children without hyperglycemia (control group). There were no differences in overall favorable visual outcome (OR 0.95, 95% CI 0.42-2.13, P = .90) or severe ROP incidence (OR 2.20, 95% CI 0.63-7.63, P = .21) between groups. Children with hyperglycemia had poorer binocular distance visual acuity (mean difference 0.08, 95% CI 0.03-0.14 logarithm of the minimum angle of resolution, P < .01), more strabismus (OR 6.22, 95% CI 1.31-29.45, P = .02), and thicker crystalline lens (mean difference 0.14, 95% CI 0.04-0.24 mm, P < .01). Maximum blood glucose concentration was greater in the ROP-treated group compared with the ROP-not treated and no ROP groups after adjusting for sex, gestational age, and birth weight z score (P = .02).

Conclusions: Neonatal hyperglycemia was not associated with overall visual outcomes at 7 years of age. However, there were between-group differences for specific outcome measures relating to interocular lens growth and binocular vision. Further follow-up is required to determine implications on long-term visual outcome.

Keywords: blood glucose; retinopathy of prematurity; visual outcome.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Blood Glucose / metabolism
Causality
Child
Cross-Sectional Studies
Female
Humans
Hyperglycemia / blood
Hyperglycemia / epidemiology*
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases
Infant, Very Low Birth Weight
Male
Retinopathy of Prematurity / blood
Retinopathy of Prematurity / epidemiology*
Risk Factors
Visual Acuity*

Substances

Blood Glucose