P0770 - Timing of Enteral Feedings as a Risk Factor for Development of Retinopathy of Prematurity

Introduction: Parenteral nutrition is known to be less beneficial to extremely premature infants than enteral feedings, with early feedings decreasing risk of necrotizing enterocolitis and bronchopulmonary dysplasia. Therefore, we evaluated the effect of timing of enteral feedings on risk of retinopathy of prematurity (ROP).

Methods: Retrospective cohort study of extremely premature infants undergoing ROP examinations at 29 North-American hospitals in 2006-2012 (The G-ROP Study). Multivariable logistic regression was used to evaluate the associations between enteral feeding status by week of life and any ROP or SEVERE ROP (ETROP Type 1 or Type 2), adjusting for birth weight and gestational age.

Results: Among 7483 infants, 3224(43.1%) had ROP, 931(12.4%) severe ROP. In multivariate analysis, compared to NPO, any enteral feeding was independently protective for any ROP and SEVERE ROP in each of weeks 1 – 6, with odds ratios ranging from 0.5 to 0.74 (p<0.0001 to p<0.02) for ANY ROP and 0.43 to 0.59 (p<0.02-0.0001) for SEVERE ROP (Table 1)

Discussion: Enteral feeding during the first 6 weeks of life was independently associated with lower risk of ROP and SEVERE ROP.

Conclusion: Based upon the largest report to date with detailed ROP data from extremely preterm infants meeting current ROP screening guidelines, enteral feeding during each of the first 6 weeks of life was strongly associated with a lower risk of ROP and severe ROP. Care protocols should be evaluated for opportunity to provide enteral feedings as early as possible during hospitalization.

References: 1. Development of Modified Screening Criteria for Retinopathy of Prematurity: Primary Results From the Postnatal Growth and Retinopathy of Prematurity Study. Binenbaum G, Bell EF, Donohue P, Quinn G, Shaffer J, Tomlinson LA, Ying GS; G-ROP Study Group. JAMA Ophthalmol. 2018 Sep 1;136(9):1034-1040.
2. Wildhaber BE, Yang H, Spencer AU, Drongowski RA, Teitelbaum DH. Lack of enteral nutrition--effects on the intestinal immune system. J Surg Res. 2005;123(1):8-16.

Submitted on behalf of the G-ROP Study Group