Risk of Retinopathy of Prematurity in Preterm Births with Respiratory Distress Syndrome: A Population-Based Cohort Study in Taiwan

Ya-Wen Lin,1 San-Ni Chen,2 Chih-Hsin Muo,3 Fung-Chang Sung,3– 5,* Ming-Hung Lin6,7,* 1School of Nursing and Graduate Institute of Nursing, China Medical University, Taichung, Taiwan; 2Department of Ophthalmology, Eye Center, China Medical University Hospital, Taichung, Taiwan; 3Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan; 4Department of Health Services Administration, China Medical University, Taichung, Taiwan; 5Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan; 6Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan; 7Department of Nursing, National Taichung University of Science and Technology, Taichung, Taiwan*These authors contributed equally to this workCorrespondence: Ming-Hung Lin, Department of Pharmacy, Chia Nan University of Pharmacy and Science, No. 60, Sec. 1, Erren Road, Rende District, Tainan City, 71710, Taiwan, Email lmh.roger@msa.hinet.net Fung-Chang Sung, Department of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Road, Beitun District, Taichung City, 406040, Taiwan, Email fcsung1008@yahoo.comBackground: Respiratory distress syndrome (RDS) is a risk factor that plays an important role in retinopathy in preterm infants. We used population data of infants to investigate this relationship. This study evaluated whether respiratory distress syndrome was associated with an increased incidence of ROP in preterm infants.Methods: From the National Health Insurance claims data of Taiwan in the 2000– 2009 period, preterm infants were identified to establish a RDS cohort (N = 7573) and a comparison cohort without RDS (N = 11428). We followed each infant for one year to identify incident retinopathy of prematurity (ROP) for comparison between the two cohorts. The RDS cohort for comparisons of hazard ratio (HR) with 95% confidence interval (CI) were calculated.Results: Low birth weight, an extended stay in the neonatal intensive care unit (NICU), female gender, and RDS were factors associated with an increased incidence of ROP. The ROP incidence was 2.5-fold higher in RDS children than in control (30.3 versus 11.9 per 100 person-years), with an adjusted HR (aHR) of 1.28 (95% CI = 1.18– 1.39). The incidence increased as the birth weight decreased in both cohorts, but the RDS cohort to the comparison cohort aHR decreased as the birth weight decreased, not significant for groups with birth weights less than 1500g. The aHR for RDS children was the highest for infants with a normal birth weight: 3.33 (95% CI = 2.09– 5.31). Among infants with RDS, the ROP incidence increased to 51.0 per 100 person-years in those who underwent invasive ventilation, or to 76.3 per 100 person-years for NICU stay for ≥ 30 days.Conclusion: Preterm infants with RDS are at an elevated risk of developing ROP, not limited to those with low birth weights.Keywords: retinopathy of prematurity, low birth weight, gestational age, preterm birth, respiratory distress syndrome