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Reduced utility of serum IGF-1 levels in predicting retinopathy of prematurity reflects maternal ethnicity
  1. M Ashwin Reddy1,2,
  2. Himanshu I Patel1,2,
  3. Shah M Karim1,
  4. Helen Lock1,
  5. Leslie Perry3,
  6. Catey Bunce2,
  7. Steve Kempley1,4,
  8. Ajay K Sinha1,4
  1. 1The Royal London Hospital, Barts Health NHS Trust, London, UK
  2. 2Moorfields Eye Hospital NHS Foundation Trust, London, UK
  3. 3Department of Clinical Biochemistry, Croydon University Hospital, London, UK
  4. 4Blizard Institute, Barts and the London School of Medicine and Dentistry, London, UK
  1. Correspondence to Maddy Ashwin Reddy, Department of Ophthalmology, Royal London Hospital, Whitechapel Road, London E1 1BB, UK; ashwin.reddy{at}bartshealth.nhs.uk

Abstract

Aims To validate known risk factors and identify a threshold level for serum insulin-like growth factor 1 (IGF-1) in the development of severe retinopathy of prematurity (ROP) in an ethnically diverse population at a tertiary neonatal unit, 2011–2013.

Methods A prospective cohort masked study was conducted. Serum IGF-1 levels at 31, 32 and 33 weeks were measured and risk factor data collected including gestational age (GA), birth weight (BW), absolute weight gain (AWG) and maternal ethnicity. The eventual ROP outcome was divided into two groups: minimal ROP (Stages 0 and 1) and severe ROP (Stage 2 or worse including Type 1 ROP).

Results 36 patients were recruited: 14 had minimal ROP and 22 severe ROP. Significant differences between the groups were found in GA, BW, AWG and IGF-1 at 32 and 33 weeks. There was minimal rise in IGF-1 in Stage 2 patients and/or black patients (p=0.0013) between 32 and 33 weeks but no pragmatic threshold level of IGF-1 that could distinguish between minimal or severe ROP.

Conclusions There were significant differences in GA, BW, AWG and IGF-1 at 32 and 33 weeks between those babies with severe ROP and those with minimal ROP. However, there was no threshold level of IGF-1 at a time point between 31 and 33 weeks that can be used to exclude a large proportion of babies from screening. We also found ethnic differences in IGF-1 levels with infants born to black mothers having significantly lower IGF-1 levels at 32 and 33 weeks gestation. The determination of ROP risk using IGF-1 is a race-specific phenomenon.

  • Biochemistry
  • Child health (paediatrics)
  • Retina
  • Treatment Lasers

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