The Protective Effect of Hyperbilirubinemia on Retinopathy of Prematurity
Adi Ben Ishai, Meydan Ben Ishai, Sarah Dollinger, Michal Schaap Fogler, Ibrahim Abu-Kishk, Bernard Barzilay
Abstract
Background: Retinopathy of prematurity (ROP) is a major cause of irreversible blindness worldwide. Oxidative injury contributes to the development of ROP, and studies have shown a possible protective effect of bilirubin on ROP because of its antioxidative traits.
Aim: To determine the association between bilirubin levels in very-low-birth-weight neonates and the severity of ROP
Materials and Methods: This is a single-center, retrospective study of all neonates weighing < 1,500 g, born between 1997 and 2015. Data about demographic characteristics, severity of ROP, and additional medical conditions were collected. An outcome score was calculated to include the prematurity-related morbidities such as ROP, bronchopulmonary dysplasia, necrotizing enterocolitis, periventricular leukomalacia, and periventricular hemorrhage.
Results: Analysis of the data of 1,477 neonates demonstrated a lower rate of significant ROP with peak bilirubin levels > 9.4 mg/dL compared with lower bilirubin levels (6% vs 10%, P = .01). ROP was also shown to have a significant correlation with additional morbidities. Peak bilirubin levels ≤ 14 mg/dL and ≤ 12 mg/dL correlate with a lower outcome score (P = .003 for each), but not for bilirubin levels ≤ 9.4 mg/dL (P = .611).
Conclusion: A narrow range of bilirubin levels might have a protective effect against ROP and additional morbidities. Further studies are warranted to determine the specific range of bilirubin level that could potentially protect against ROP without increasing the risk of other complications of prematurity.
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