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CC BY 4.0 · Am J Perinatol 2025; 42(03): 387-394
DOI: 10.1055/a-2369-6690
Original Article

Early-Onset Sepsis as an Early Predictor for Retinopathy of Prematurity: A Meta-analysis

Salma El Emrani 
1   Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
2   Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
,
Lotte E. van der Meeren
3   Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
4   Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands
,
Esther J.S. Jansen
5   Neonatology, Department of Women and Neonate, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
,
Jelle J. Goeman
6   Medical Statistics, Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
,
Jacqueline U.M. Termote
5   Neonatology, Department of Women and Neonate, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
,
Enrico Lopriore
2   Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
,
Nicoline E. Schalij-Delfos
1   Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations Funding This study was funded by ODAS Foundation (grant no.: 2021-32327). ODAS Foundation had no role in the design or conduct of the study.
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Abstract

Objective Neonatal sepsis has been established as a risk factor for retinopathy of prematurity (ROP) but previous meta-analyses have predominately focused on late-onset sepsis (LOS). This meta-analysis aims to explore the association between early-onset sepsis (EOS) and the risk of ROP.

Study Design Observational studies reporting (unadjusted) data on proven EOS in neonates with ROP were included. PubMed, Embase, and Cochrane Library were searched. Proven EOS was defined as a positive blood or cerebrospinal fluid culture. Effect sizes were calculated by using logistic random-effects models and meta-regression analyses. Primary outcomes were any stage ROP and severe ROP (≥stage 3, type I, aggressive [posterior] ROP, plus disease or requiring treatment). Potential confounders explored were gestational age at birth, birth weight, small for gestational age, maternal steroid use, necrotizing enterocolitis, LOS, and mechanical ventilation duration.

Results Seventeen studies reporting the incidence of proven EOS in neonates with ROP were included. Proven EOS showed no significant association with any stage ROP (odds ratio [OR] = 1.90; 95% confidence interval [CI]: 0.96–3.79, p = 0.067) but heterogeneity between studies was significantly high. Neonates with proven EOS had an increased risk for severe ROP (OR = 2.21; 95% CI: 1.68–2.90), and no significant confounders influencing this effect size were found in the meta-regression analysis.

Conclusion Neonates with proven EOS are at increased risk of severe ROP. Neonatologists need to be aware that EOS is an early predictor of ROP and should adapt their policy and treatment decisions where possible to reduce ROP.

Key Points

  • This meta-analysis reveals a 2.2-fold increased risk of severe ROP in neonates with proven EOS.

  • Future studies should distinguish between EOS and LOS when investigating risk factors of ROP.

  • Treatment decisions should be adapted where possible in neonates with EOS before ROP screening begins.

Keywords

retinopathy of prematurity - early-onset sepsis - prematurity - meta-analysis

Supplementary Material



Publication History

Received: 09 April 2024

Accepted: 16 July 2024

Accepted Manuscript online:
19 July 2024

Article published online:
13 August 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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