626 - Impact of Early Caloric and Macronutrient Intake on Retinopathy of Prematurity in Infants Born at Gestational Age <26 Weeks

Publication Number: 1603.626

Sonola Burrja, Albert Einstein College of Medicine, Brooklyn, NY, United States; Miranda Martinez-Hussain, Geisinger Commonwealth School of Medicine, Danville, PA, United States; Eric Basile, The Children's Hospital at Montefiore, Bronx, NY, United States; Kasra Jabbary Moghaddam, Albert einstein medical school, New York, NY, United States; Jee-Young Moon, Jee-Young Moon, BRONX, NY, United States; Umar Mian, Albert Einstein College of Medicine, Bronx, NY, United States; Shantanu Rastogi, The Children's Hospital at Montefiore, Bronx, NY, United States

Background: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide. While prematurity, low birth weight (BW), and oxygen therapy are known risk factors, the role of early postnatal nutrition and weight gain is less well defined, particularly among infants born at < 26 weeks' gestational age (GA). Emerging evidence links poor early growth to greater ROP severity. However, the associations among nutrition (e.g., enteral versus total parenteral nutrition [TPN]), its components, neonatal growth rate, and ROP severity remain unclear.

Objective: To evaluate associations between early postnatal nutrition (enteral and TPN), caloric and macronutrient (carbohydrate, protein, lipid) intake, and growth velocity with ROP treatment as a measure of severe ROP, among premature infants born at < 26 weeks' GA.

Design/Methods: This single-center case-control study included infants born < 26 weeks' GA at Montefiore Medical Center (Jan 2016-Jul 2024). Of 134 eligible infants with ROP, 24 required treatment and were matched 2:1 by GA and BW with 48 untreated controls. Daily weights and nutrition data from 28-36 weeks' corrected GA (cGA) were used to calculate growth velocity and assess TPN and enteral intake of calories, protein, lipids, and carbohydrates. ROP staging and treatment followed the ICROP. Baseline comparisons used Welch's t-test and Fisher's exact test. Regression adjusted for significant factors from univariate analysis and mixed-effects models accounted for repeated daily measures within infants, adjusting for sex, GA, BW, and oxygen exposure.

Results: Univariate analysis showed treated infants had higher maximum oxygen exposure, more transfusions, greater postnatal steroid use, and higher rates of patent ductus arteriosus, pneumothorax, and urinary tract infections. At 32 weeks' cGA, higher total carbohydrate intake (p=0.03) and higher TPN-derived caloric (p=0.03), protein (p=0.02), and carbohydrate (p=0.049) intake-after adjusting for TPN days-were linked to ROP treatment, while a higher proportion of enteral calories was inversely associated (p=0.03). In mixed-effects analysis, higher total carbohydrate intake (p=0.02) correlated with ROP severity, whereas higher TPN caloric, protein, and carbohydrate intake approached significance for ROP treatment. Enteral intake, though not significant, showed a protective effect against ROP severity.

Conclusion(s): Higher total carbohydrate intake was associated with an increased likelihood of severe ROP requiring treatment. The contributions of total calories, carbohydrates, proteins, and lipids from parenteral and enteral sources warrant further study.

Demographic and clinical characteristics of cases and controls
Values are presented as mean ± SD, median (IQR), or n (%). P-values were calculated using Welch's t-test for continuous variables and Fisher's exact test for categorical variables.

Linear regression analyses of nutritional factors associated with ROP treatment at 32 weeks' cGA and mixed-effects analysis across postnatal weeks, adjusted for sex, GA, BW, and oxygen exposure
β values represent differences between ROP-treated and untreated infants (treated - untreated). Positive β values indicate higher intake in treated infants. P-values correspond to group differences based on the specified model.