Postnatal Serum Insulin-Like Growth Factor I Deficiency Is Associated With Retinopathy of Prematurity and Other Complications of Premature Birth

• Published in: Pediatrics (Evanston) 2003-11, Vol.112 (5), p.1016-1020
• Main Authors: Hellstrom, Ann, Engstrom, Eva, Hard, Anna-Lena, Albertsson-Wikland, Kerstin, Carlsson, Bjorn, Niklasson, Aimon, Lofqvist, Chatarina, Svensson, Elisabeth, Holm, Sture, Ewald, Uwe, Holmstrom, Gerd, Smith, Lois E. H
• Format: Article
• Language: English
• Subjects: Babies; Biological and medical sciences; Birth Weight; Bronchopulmonary Dysplasia - blood; Bronchopulmonary Dysplasia - epidemiology; Cerebral Hemorrhage - blood; Cerebral Hemorrhage - epidemiology; Enterocolitis, Necrotizing - blood; Enterocolitis, Necrotizing - epidemiology; Fetal Growth Retardation - blood; Gestational Age; Humans; Infant, Newborn; Infant, Premature - blood; Insulin; Insulin-Like Growth Factor I - analysis; Insulin-Like Growth Factor I - deficiency; Longitudinal Studies; Medical disorders; Medical sciences; Neurology; Ophthalmology; Pediatrics; Premature birth; Prospective Studies; Retinopathies; Retinopathy of Prematurity - blood; Retinopathy of Prematurity - epidemiology; Risk Factors; Severity of Illness Index; Sweden - epidemiology; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.112.5.1016

Insulin-like growth factor I (IGF-I) is necessary for normal development of retinal blood vessels in mice and humans. Because retinopathy of prematurity (ROP) is initiated by abnormal postnatal retinal development, we hypothesized that prolonged low IGF-I in premature infants might be a risk factor for ROP. We conducted a prospective, longitudinal study measuring serum IGF-I concentrations weekly in 84 premature infants from birth (postmenstrual ages: 24-32 weeks) until discharge from the hospital. Infants were evaluated for ROP and other morbidity of prematurity: bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), and necrotizing enterocolitis (NEC). Low serum IGF-I values correlated with later development of ROP. The mean IGF-I +/- SEM level during postmenstrual ages 30-33 weeks was lowest with severe ROP (25 +/- 2.41 micro g/L), 29 +/- 1.76 micro g/L with moderate ROP, and 33 +/- 1.72 micro g/L with no ROP. The duration of low IGF-I also correlated strongly with the severity of ROP. The interval from birth until serum IGF-I levels reached >33 micro g/L was 23 +/- 2.6 days for no ROP, 44 +/- 4.8 days for moderate ROP, and 52 +/- 7.5 days for severe ROP. Each adjusted stepwise increase of 5 micro g/L in mean IGF-I during postmenstrual ages 30 to 33 weeks decreased the risk of proliferative ROP by 45%. Other complications (NEC, BPD, IVH) were correlated with ROP and with low IGF-I levels. The relative risk for any morbidity (ROP, BPD, IVH, or NEC) was increased 2.2-fold (95% confidence interval: 1.41-3.43) if IGF-I was