Key messages
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Current evidence does not allow firm conclusions regarding the safety of treatment with insulin-like growth factor-1, a protein that helps blood vessels in the retina of the eye grow normally, in premature babies born before term and weighing less than 1500 grams.
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Current evidence does not allow firm conclusions regarding the effect of insulin-like growth factor-1 treatment for prevention of retinopathy of prematurity, a disease in premature babies where blood vessels in the back of the eye do not grow normally.
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So far, studies of insulin-like growth factor-1 in preterm infants may not detect important benefits or side effects.
What are retinopathy of prematurity and insulin-like growth factor-1?
Retinopathy of prematurity is a common disease in babies born prematurely with a birth weight less than 1500 grams. It is caused when blood vessels in the back of the eye do not grow normally. Retinopathy of prematurity can cause vision problems or blindness.
Insulin-like growth factor-1 is a protein that helps blood vessels in the retina of the eye grow normally during pregnancy. When babies are born too early, they may not have enough insulin-like growth factor-1 in their bodies and this may cause blood vessels in the retina to grow abnormally, leading to the development of retinopathy of prematurity.
How is retinopathy of prematurity treated?
Currently, retinopathy of prematurity is treated with lasers that burn the retina in the back of the baby's eye to stop stimulation of the abnormal blood vessels that may damage vision, or with medications that are injected into the eye to temporarily stop the abnormal blood vessels from continuing to grow and damage vision.
What did we want to find out?
We wanted to find out if giving insulin-like growth factor-1 to premature babies prevents or treats retinopathy of prematurity. We also wanted to find out if giving insulin-like growth factor-1 to premature babies causes any serious side effects or problems, or had an effect on any other medical issues caused by prematurity, like brain bleeding or lung disease of prematurity.
What did we do?
We searched for research studies that compared treatment with insulin-like growth factor-1 either to a placebo (a ‘dummy’ or sham treatment) or to standard care, which is usual neonatal intensive care unit (NICU) care that does not normally include giving insulin-like growth factor-1, in premature babies who were at risk of developing retinopathy of prematurity. We compared and summarized the results of the studies and rated our confidence in the evidence based on study methods and size.
What did we find?
We included two studies with a total of 140 premature babies. The included studies tested insulin-like growth factor-1 treatment in premature babies and followed their outcomes through five to six years of age.
We found that the results of current studies do not allow for a definite conclusion regarding its efficacy for preventing or treating retinopathy of prematurity. The results of current studies also do not allow for a definite conclusion regarding the safety of insulin-like growth factor-1 treatment in premature babies, including harmful effects or death.
What are the limitations of the evidence?
Our confidence in the evidence is very low, and the results of further research could differ from the results of this review. Two main factors reduced our confidence in the evidence. First, we only identified two studies of insulin-like growth factor-1 treatment in premature infants and not many infants participated in them. This means there may not have been enough participants who received treatment to determine whether it actually made a difference. Second, the studies we found had problems with their design or the way they were conducted, which may affect the accuracy of their results.
How up to date is this evidence?
The evidence is up-to-date to March 2025.
Read the full abstract
Objectives
To compare treatment with IGF-1 to standard care or placebo for the prevention of retinopathy of prematurity or treatment of early retinopathy of prematurity.
Search strategy
We used CENTRAL, MEDLINE, Embase, Cochrane Database of Systematic Reviews, Issue 3, 2025, in the Cochrane Library, CINAHL Plus with Full Text (EBSCOhost), Epistemonikos, clinical trials registries (US National Library of Medicine Clinicaltrials.gov, World Health Organization’s International Trials Registry Platform, and ISRCTN Registry), together with reference checking and citation searching to identify studies that are included in this review. The latest search date was 10 March 2025.
Authors' conclusions
The available data are of very low certainty, and so we are not able to draw conclusions about the effects of treatment with IGF-1 in preterm infants for preventing or treating ROP, or about its effects on risk of serious adverse events, mortality, or hypoglycemia in this population.
Funding
This Cochrane review had no dedicated funding.
Registration
Protocol available via DOI: 10.1002/14651858.CD013216
