Systemic fungal infection and ROP

Systemic fungal infection and ROP

Bharwani SK, Dhanireddy R. Systemic fungal infection is associated with the development of retinopathy of prematurity in very low birth weight infants: a meta-review. J Perinatol 2008; 28:61-66 Full Text | PDF

Objective: To study the association between systemic fungal infection (SFI) and the development of retinopathy of prematurity (ROP) and severe ROP in very low birth weight (VLBW) infants by systematic review and meta-analysis.

Study Design: A meta-review was performed using a fixed effects model. The exposure and outcomes studied were SFI and all ROP/severe ROP, respectively in VLBW infants. Results and effect sizes analyzed with Review Manager 4.2 software are expressed as relative risk (RR), odds ratio (OR), risk difference (RD) and number needed to harm (NNH) with 95% confidence intervals.

Result: Data for severe ROP were available from eight studies and on all ROP from seven of those eight studies. Estimated gestational age ranged from 24.7±1.6 to 28.6±4 weeks and birth weight from 673 (median) (range 426 to 995) to 1108±266 g (mean±s.d.). A total of 261 of 303 babies with SFI had all ROP vs. 1081 of 1648 babies without SFI (OR 3.4*, 2.34–4.95) and 118 of 330 babies with SFI had severe ROP vs. 235 of 1951babies without SFI (OR 4.06*, 3.05–5.42). The NNH was 5.56* (4.54–7.14) for all ROP and 4.54* (3.70 to 5.88) for severe ROP (*P<0.00001).

Conclusion: SFIs are associated with the development of all degrees of ROP and severe ROP in VLBW infants.

Comments: Fungal sepsis as a risk factor for ROP is described in the literature. All the studies done in the past and included in this meta-review are retrospective studies. Similarly, the populations studied were also different with some including ELBW babies only. The salient feature in this meta-review is the excellent homogeneity found among the studies (I²=0%). A similar retrospective study done to identify the risk factors for threshold ROP in our tertiary care unit showed packed RBC’s transfusion and blood exchange transfusion to be independent risk factors for threshold ROP. It’s time for a prospective analysis (VS).

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