Incidence, risk factors of retinopathy of prematurity among very low birth weight infants in Singapore.
Incidence, risk factors of retinopathy of prematurity among very low birth weight infants in Singapore.
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DOI：
10.47102/annals-acadmedsg.v34n2p169
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发表时间：
2005-03
期刊：
影响因子：
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通讯作者：
V. Shah;Clayton Yeo;Y. Ling;L.O.L. Ho
中科院分区：
文献类型：
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作者：
V. Shah;Clayton Yeo;Y. Ling;L.O.L. Ho
目的探讨极低出生体重儿（VLBW）早产儿视网膜病变（ROP）的发生率、危险因素和手术需求。材料与方法本研究是对1988年至2001年期间该科管理的所有VLBW婴儿进行回顾性研究。早产儿按照皇家眼科学院的指南进行检查，视网膜病变按照国际ROP分类进行分级。所有接受ROP检查的极低体重婴儿均被纳入研究，回顾性检索数据，并使用逻辑回归分析产妇、医疗、产科和新生儿风险因素。结果564例符合筛查标准的VLBW患儿中，165例（29.2%）患儿检出ROP；其中49%的婴儿患有1期疾病，24%处于2期，27%处于3期或以上。在45名患有3期或以上疾病的婴儿中，62.2%（28/45）需要治疗。妊娠大于33周的婴儿未发现ROP。只有0.6%（1/164）的大于30周胎龄的婴儿需要手术治疗ROP。根据出生体重（BW）标准，只有1%（6/564）的婴儿体重为1000 g时出现3期ROP。在所有需要手术的ROP中，89%（25/28）的婴儿是1000克的婴儿。ROP发病的中位年龄为35周（范围31 ~ 41），校正年龄。通过对阈值ROP的单因素分析，子痫前期、产前倍他米松暴露、胎龄、出生体重、1分钟Apgar评分、透明膜病（HMD）、表面活性物质使用、低血压、败血症、脑室内出血、补充氧持续时间、通气和慢性肺部疾病与ROP需要手术相关（即阈值ROP， P <0.05）。然而，对ROP进行多元logistic回归分析，母体子痫前期[优势比（OR）， 2.52；可信区间（CI）， 1.32 ~ 4.7]、出生体重（OR, 0.99； CI, 0.996 ~ 0.999）、肺出血（OR, 4.61； CI, 1.04 ~ 20.4）、通气时间（OR, 1.06； CI, 1.04 ~ 1.08）和持续气道正压通气（CPAP）持续时间（OR, 1.02； CI, 1.01 ~ 1.04）是预测阈值ROP发生的因素。结论VLBW患儿ROP发生率为29.2%。ROP与更小、更不成熟和病情更重的婴儿密切相关。ROP发病的中位年龄为经后35周（范围31 - 40周）。出生年龄<30周的婴儿和/或体重<1000 g的婴儿有相当大的阈值ROP风险。回归分析阈值ROP发生的主要危险因素为母体子痫前期、出生体重、是否存在肺出血、通气时间和持续正压通气时间。我们认为不成熟和肺功能受损都是发生ROP的重要病因。预防早产，控制先兆子痫，明智地使用通气和氧疗是唯一有希望降低这一高危婴儿ROP发生率和严重程度的因素。
INTRODUCTION To determine the incidence, risk factors and need for surgery for retinopathy of prematurity (ROP) among very-low-birth-weight (VLBW) infants. MATERIALS AND METHODS This was a retrospective study of all VLBW infants managed by the department over 14 years, from 1988 to 2001. Preterm infants were examined according to the Royal College of Ophthalmologists' guidelines, and retinopathy was graded following the International Classification of ROP. All VLBW infants examined for ROP were included and data were retrieved retrospectively and analysed for maternal, medical, obstetric and neonatal risk factors using logistic regression. RESULTS Of the 564 VLBW infants who fit the screening criteria, ROP was detected in 165 (29.2%) of VLBW infants; of whom 49% of infants had stage 1 disease, 24% were at stage 2, and 27% were at stage 3 or more. Among 45 infants with stage 3 disease or more, treatment was needed in 62.2% (28/45). No ROP was detected in infants greater than 33 weeks of gestation. Only 0.6 % (1/164) of infants greater than 30 weeks of gestational age (GA) needed surgery for ROP. Using birth weight (BW) criteria, stage 3 ROP was noted only in 1% (6/564) of infants with BW >1000 g. Of all ROP requiring surgery, 89% (25/28) of infants were 1000 g infants. The median age of onset of ROP was 35 weeks (range, 31 to 41) corrected age. By univariate analysis for threshold ROP, preeclampsia, prenatal betamethasone exposure, gestational age, birth weight, 1-minute Apgar score, hyaline membrane disease (HMD), surfactant usage, hypotension, septicaemia, intraventricular haemorrhage duration of supplemental oxygen, ventilation and chronic lung disease were associated with ROP requiring surgery (i.e., threshold ROP, P <0.05). However, using multiple logistic regression analyses for ROP, maternal preeclampsia [odds ratio (OR), 2.52; confidence interval (CI), 1.32 to 4.7], birth weight (OR, 0.99; CI, 0.996 to 0.999), pulmonary haemorrhage (OR, 4.61; CI, 1.04 to 20.4), duration of ventilation (OR, 1.06; CI, 1.04 to 1.08) and duration of continuous positive airway pressure (CPAP) (OR, 1.02; CI, 1.01 to 1.04) were factors predictive of development of threshold ROP. CONCLUSION The incidence of ROP among VLBW infants was 29.2%. ROP was strongly associated with smaller, more immature and sicker infants. The median age of onset of ROP was 35 weeks (range, 31 to 40 weeks) postmenstrual age. Infants <30 weeks of GA and/or infant with BW <1000 g are at considerable risk for threshold ROP. The main risk factors for development of threshold ROP by regression analysis are maternal preeclampsia, birth weight, and presence of pulmonary haemorrhage, duration of ventilation and continuous positive pressure ventilation. We suggest that both immaturity and compromised pulmonary function are both important aetiological factors in the development of ROP. Prevention of prematurity, control of preeclampsia, judicious use of ventilation and oxygen therapy are the only promising factors that may reduce the incidence and severity of ROP in this high-risk infant.