Sildenafil and Retinopathy of Prematurity in Preterm Infants with Bronchopulmonary Dysplasia

Objective To assess whether sildenafil is associated with worsening retinopathy of prematurity (ROP) in very low birth weight (VLBW) infants (<= 1500 g) with bronchopulmonary dysplasia (BPD). Study design This retrospective case-control study included VLBW infants admitted to the neonatal intensive care unit between January 1, 2006, and December 31, 2012. Each infant treated with sildenafil was assigned 3 unexposed controls matched for gestational age, birth weight, and BPD diagnosis. Severe ROP was defined as stage >= 3 ROP. Worsening ROP was defined as increased stage of ROP within 8 weeks + 4 days after initiation of sildenafil or matched postmenstrual age. Results Twenty-three exposed infants and 69 matched controls met the inclusion criteria for the study (mean birth weight, 715 +/- 210 g; mean gestational age, 25 +/- 1 weeks). The mean postmenstrual age at sildenafil treatment was 42 +/- 8 weeks. Exposed infants had more days of respiratory support (mean, 208 +/- 101 days vs 102 +/- 33 days; P < .001). Exposed infants had a higher prevalence of severe ROP (26% [6 of 23] vs 7% [5 of 69]; OR, 6.4; 95% CI, 1.2-32.9; P= .026). Five exposed infants and 2 unexposed infants had severe ROP before starting sildenafil and were excluded from the analysis for worsening ROP. The rate of worsening ROP did not differ significantly between exposed infants and unexposed infants ((41% [7 of 17] vs 24% [12 of 51]; OR, 8.4; 95% CI, 0.9-78.6; P = .061). Conclusion Although sildenafil treatment was not statistically significantly associated with worsening of ROP, the raw difference in ROP rate is concerning. Larger studies are warranted to confirm this finding.