Effect of gestational age and birth weight on the risk of strabismus among premature infants.
Effect of gestational age and birth weight on the risk of strabismus among premature infants.
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DOI：
10.1001/jamapediatrics.2014.946
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发表时间：
2014-09
期刊：
影响因子：
26.1
通讯作者：
Stein, Joshua D.
中科院分区：
文献类型：
--
作者：
Gulati, Shilpa;Andrews, Chris A.;Apkarian, Alexandra O.;Musch, David C.;Lee, Paul P.;Stein, Joshua D.
如果不及早发现和治疗，斜视会导致不可逆转的视力丧失。目前尚不清楚出生体重(BW)和胎龄(GA)是否为斜视的危险因素。评估体重和出生体重对早产儿发展为斜视的可能性的影响。在这项纵向队列分析中，我们对一组早产儿从出生起就进行了跟踪，以确定发生斜视的比例和首次诊断为斜视的时间。多变量COX回归分析评估了体重和视力与斜视发展的关系。回归模型针对斜视、社会人口学因素和眼部合并症的其他已知危险因素进行了调整。在2001年至2011年间，全美有38055名健康的早产儿在全国范围内参加了为期6个月的管理保健网络。斜视的BW<；2000G或GA<；32周危险比(HR)与95%可信区间(CI)在38055名早产的健康儿童中，587名在以后的生活中被诊断为斜视。术后5年斜视累计发生率为3.0%。控制GA和其他因素，出生时患有BW<；2000G的婴儿患斜视的风险增加了61%(HR=1.61；[CI 1.22-2.13])。控制体重和其他协变量后，斜视与GA之间没有显著关联(HR=0.98，[CI，0.69-1.38])。在出生体重和体重为2000G的早产儿中，GA≤32周与32周后出生的早产儿相比，患斜视的风险没有增加(HR=1.27，[CI，0.86-1.88])。相比之下，在GA≤为32周的患者中，BW<；2000G患斜视的风险是BW>；2000G的14倍(HR=14.4，[CI 1.99-104])。与GA无关，极低的体重会显著增加早产儿的斜视风险。相反，与体重无关，GA对斜视的风险没有显著影响。应该考虑更新儿科和眼科文献中的现有指南，强调体重而不是GA的重要性，并提醒临床医生需要仔细监测低体重早产儿的斜视。
Strabismus causes irreversible vision loss if not detected and treated early. It is unclear whether birth weight (BW) and gestational age (GA) are risk factors for strabismus. To estimate the impact of BW and GA on the likelihood of developing strabismus among premature infants. In this longitudinal cohort analysis, we followed a group of premature children from birth to determine the proportion which developed strabismus and the timing of first strabismus diagnosis. Multivariable Cox regression analyses assessed the relationships of BW and GA and the development of strabismus. Regression models were adjusted for other known risk factors for strabismus, sociodemographic factors, and ocular comorbidities. Communities throughout the United States 38055 otherwise healthy children born prematurely who were enrolled for >6 months in a nationwide US managed care network between 2001–2011. BW <2000g or GA <32 weeks Hazard ratios (HRs) for strabismus with 95% confidence intervals (CIs) Of 38055 otherwise healthy children who were born prematurely, 587 were diagnosed with strabismus later in life. Cumulative incidence of strabismus was 3.0% at 5 years. Controlling for GA and other factors, infants born with BW <2000g had a 61% increased hazard (HR=1.61; [CI 1.22–2.13]) of developing strabismus. Controlling for BW and other covariates, there was no significant association between strabismus and GA (HR=0.98, [CI, 0.69–1.38]). Among premature infants with BW <2000g, GA ≤32 weeks conveyed no additional increased risk for developing strabismus relative to those born after 32 weeks (HR=1.27, [CI, 0.86–1.88]). In contrast, among those with GA ≤32 weeks, BW <2000g conveyed a 14-fold increase in the risk of strabismus relative to BW >2000g (HR=14.4, [CI 1.99–104]). Independent of GA, very low BW conferred a large increase in strabismus risk among premature infants. In contrast, independent of BW, GA did not significantly impact the risk of strabismus. Updates to existing guidelines in the pediatric and ophthalmic literature should be considered, highlighting the importance of BW rather than GA and alerting clinicians about the need for careful monitoring of premature infants of low BW for strabismus.
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