Evaluation of breast milk and other risk factors in the development of retinopathy of prematurity in premature infants at and below 34 weeks of gestation

Objectives: The aim of this study was to investigate the development of retinopathy of prematurity in preterm infants followed up in the Neonatal Intensive Care Unit of Ondokuz Mayıs University Faculty of Medicine Hospital, the frequency of progression to the disease requiring treatment and the relationship between breast milk intake and other risk factors in the development of retinopathy of prematurity. Materials and Methods: Our study was designed as a retrospective, single-center study. Between January 1, 2017 and June 30, 2022, 318 premature infants born ≤34 gestational age who were followed up in the Pediatrics Neonatal Intensive Care Unit of Ondokuz Mayıs University Hospital were enrolled in the study. Data related to the prenatal, natal and postnatal periods were retrospectively analyzed by reviewing the patient data recorded in the Neonatal Intensive Care Unit of our department and the hospital information management system. The statistical analyses were performed using the SPSS for mac version 26 software. Results: A total of 318 patients met the inclusion criteria and 92(28.9%) had retinopathy of prematurity. The mean birth weight of the patients weighed 1470±445.89 gr, 21(6.6%) were in <28 gestational age group, 160(50.3%) were in 28-31 gestational age group, 137(43.1%) were in 32-34 gestational age group and 17 of the patients whose data could not be reached were born at <28 gestational age. The mean age of the mothers included in the study was 30.01 5.65 years, 52 (56.5%) had gestational disease, 19 (20.7%) had chronic disease, and 122 (69.7%) of the mothers were administered antenatal steroid. It was observed that 135 (42.5%) of the patients were exclusively fed with maternal breast milk, 106 (33.3%) were fed with combination of breast milk and formulas, and 77 (24.2%) were fed only with formulas. Of the 92 neonates who were found to have ROP, 55 neonates were in stage 1 (59.8%), 24 in stage 2(26.1%), 13 in stage 3(14.1%) and 3 in A-ROP(3.3%), there were no stage 4A, stage 4B and stage 5 of the disease. Intravitreal anti-VEGF was administered to 20(21.2%) of the neonates and spontaneous regression was achieved in 70(76.1%) of the neonates with ROP. In our study, the rate of ROP was found to be lower in neonates who were exclusively fed with maternal breast milk and neonates receiving a combination of breast milk and formulas compared to neonates receiving only formulas. In our study as expected, the rate of development of ROP was the highest with decreasing gestational age and birth weight. Many factors such as maternal age, presence of maternal chronic disease, method of conception, mode of delivery, gender, anthropometric measurements such as being SGA, LGA or AGA , colostrum intake, presence of hyperglycemia, number of days in high frequency oscillatory ventilation mode, corticosteroid treatment for BPD, type of PDA treatment and number of courses used, dopamine and dobutamine use, early/late neonatal sepsis, duration of antibiotic use in sepsis and degree of GMH-IVH were not found to be risk factors for the development of ROP. There exists significant correlation between maternal gestational disease and development of ROP. Other potential risk factors for the development of ROP include prolonged duration of transition to full enteral nutrition, prolonged TPN intake, low discharge weight, RDS, BPD, apnea, prolonged duration of caffeine treatment, surfactant use and the need for repeated surfactant doses, increased number of sepsis attacks, prolonged IMV, prolonged NIMV, prolonged duration of oxygen supplementation, increased number and need for transfusion, presence of PDA, presence of hypotension, need for inotropic support, high VIS and presence of GMH-IVH increased the development of ROP. In this study, it was found that in infants in the high-risk group for the development of ROP, the rate of advanced stage of ROP and any stage of ROP after discharge was lower in the breast milk fed group during hospitalization compared to the group not receiving breast milk. In addition to the breast milk in the diet, short transition time to full enteral nutrition was also found to be an important factor in preventing the development of ROP. Conclusion: The important contribution of breast milk in the nutrition of premature infants should be added to its protective feature against ROP, as shown in our study, breast milk intake reduces the risk of ROP and the likelihood of developing advanced stages of ROP in high-risk groups. Keywords: Human breast milk, retinopathy of prematurity(ROP), risk factors.