早产儿视网膜病的筛查及其高危因素分析

目的 分析早产儿视网膜病(ROP)的危险因素,为合理防治ROP提供理论依据.方法回顾分析2006年7月至2008年5月,我院NICU住院的胎龄≤36周、出生体重≤2500 g行ROP筛查的1675例早产儿临床资料.记录早产儿的性别、胎数、孕周、出生体重、用氧情况、患全身疾病情况及孕母情况.同时用单因素χ~2检验和多因素Logistic回归分析筛选和判定早产儿ROP发生的危险因素.结果 1675例早产儿中,发生ROP 195例,ROP患病率为11.6%.195例ROP患儿中,达到阈值前病变Ⅰ型或阈值病变者35例,占筛查早产儿的2.1%.ROP发生的相关因素分析发现,出生体重越低、胎龄越小、氧疗时间越长,ROP患病率越高.Logistic回归分析结果 表明,低出生体重、小胎龄、窒息、呼吸暂停、氧疗是ROP发生的高危因素(OR值分别为0.957、1.052、1.186、5.314、1.881).结论 低出生体重、小胎龄、窒息、呼吸暂停、氧疗是ROP发生的高危因素,建议对具有高危因素的所有早产儿均进行ROP筛查.     

早产儿视网膜病的高危因素分析

目的了解我院早产儿视网膜病（refinopathy of prematurity,ROP）的发病状况,并对其高危因素进行分析。方法对2010年1月至2012年12月在我院新生儿科住院的早产儿（胎龄≤36周,体重≤2．5kg）,于生后2周进行ROP筛查,并定期随访。将患儿全身状况及吸氧、母孕期吸氧、先兆子痫、胎盘早剥等因素进行分析。结果255例患儿全部完成了眼底筛查,在周边视网膜血管化或病变退化后终止随访,发现ROP16例（26只眼）,ROP患病率为6．3％（5．1％）,其中Ⅰ期12例,Ⅱ期3例,Ⅲ期1例。高危因素分析示胎龄、出生体重、吸氧时间,吸氧浓度、机械通气与ROP相关（P〈0．05）;母孕期吸氧、先兆子痫、胎盘早剥等因素与ROP发病无关。结论早产、吸氧浓度高、机械通气是ROP的主要危险因素。对早产儿适时进行ROP筛查,并对发现的ROP早期进行有效视网膜激光光凝术,可控制病变,降低早产儿的致盲率。     

浙江地区早产儿视网膜病筛查1225例分析

目的 了解早产儿ROP发病状况,探索早产儿ROP筛查的临床策略.方法 按照"早产儿治疗痒和视网膜病变防治指南"中的ROP筛查标准用间接眼底镜对浙江两家医院新生儿监护室(NICU)住院的早产儿进行ROP筛查.结果 2005年3月至2008年11月间共筛查1225例住院早产儿,发生ROP132例(10.8%),高风险阈前ROP12例(0.98%),阈值ROP4例(0.3%);其中未吸氧的早产儿65例,发生低风险阈前ROP1例(1.5%);两者差异有极显著性意义(x2=5.115,P＜0.01).有与无ROP组出生体重或胎龄的比较,差异均有极显著意义(分别F=26.39,19.73,P＜0.001);与出生体重或胎龄呈负相关(r=-0.145,-0.126,P＜0.000).不同出生体重或胎龄的早产儿发生ROP的比较,差异亦有极显著意义(x2=39.53,31.40,P＜0.001);体重≤1000 g的早产儿发生ROP是体重＞1000 g的3倍多,胎龄≤28周的早产儿发生ROP是＞28周的2.5倍.性别和多胎与ROP无明显相关性,差异无统计学意义(x2=0.279,3.449,P＞0.05).高风险阈前和阈值ROP与患儿反复呼吸暂停、多次窒息抢救及当地用氧抢救史相关(r=0.54,0.57,0.57,P＜0.05).阈值ROP患儿均有氧依赖、反复呼吸暂停及窒息.结论 ROP的发生与出生体重和胎龄负相关,体重≤1000 g或胎龄≤28周的有吸氧史的早产儿在筛查中要予以特别关注;通过筛查,ROP及时发现并在阈值期得到治疗,减少了盲童.     

早产儿视网膜病防治进展

近年来，早产儿视网膜病(ROP)发病率随着早产儿存活率的提高而相应增加。ROP一旦出现牵拉性视网膜剥离，则失明率和致残率高、ROP临味进展分为5期，其治疗方法依病程早晚而异，包括药物治疗、氧疗、手术治疗等。目前、在3期ROP行外周性视网膜消融术疗效最理想，因此，必需建立完备有效的ROP筛查制度、争取做到早诊断、早治疗。     

早产儿视网膜病的高危因素分析

为了研究早产儿视网膜病（ＲＯＰ）的发病率、高危因素及预后，对１４９例极低出生体重儿与ＲＯＰ的关系进行了回顾性分析。结果：ＲＯＰ５９例（４０％）；其中ＲＯＰ１期３２例（５４％），ＲＯＰ２期１６例（２７％），ＲＯＰ３期１１例（１９％）。所有ＲＯＰ３期患儿均患有散光或散光＋近视。通过对用氧时间，出生体重等２０种高危因素与ＲＯＰ严重程度的综合分析，发现长期使用氧气和出生低体重是造成ＲＯＰ的重要原因。建议缺乏用氧指征的早产儿切勿用氧。     

早产儿视网膜病防治进展

近年来 ,早产儿视网膜病 (ROP)发病率随着早产儿存活率的提高而相应增加。ROP一旦出现牵拉性视网膜剥离 ,则失明率和致残率高。ROP临床进展分为 5期 ,其治疗方法依病程早晚而异 ,包括药物治疗、氧疗、手术治疗等。目前 ,在 3期ROP行外周性视网膜消融术疗效最理想 ,因此 ,必需建立完备有效的ROP筛查制度 ,争取做到早诊断、早治疗     

早产儿视网膜病的危险因素分析及随访调查

研究早产儿视网膜病(retinopathy of prematurity,ROP)的发生率、高危因素、治疗与随访情况。方法对2005年7月-2007年12月温州医学院附属第一医院NICU收治的符合ROP筛查标准的早产儿,于生后2周开始由资深眼科医师开始行间接眼底镜检查眼底,并进行随访。结果434例早产儿中ROP的发生率为5.5%(24/434例),24例ROP中Ⅰ期19例,Ⅱ期3例,Ⅲ期2例。Ⅲ期阈值病变者行激光光凝治疗,全部患儿均恢复正常。对434例早产儿行单因素分析得出,胎龄、出生体重、住院时间、吸氧、吸氧浓度、吸氧时间、呼吸暂停、新生儿肺透明膜病(RDS)、肺表面活性剂(PS)的应用、机械通气、输血、光疗时间、感染与ROP的发生有相关性(P<0.05)。Logistic回归分析显示胎龄、出生体重、胎数、吸氧时间、光疗时间、代谢性酸中毒、母亲妊高症、颅内出血是影响ROP发生的主要因素。结论早产是ROP的根本原因,防治各种并发症、合理的氧疗是预防ROP的关键。建立完善有效的ROP筛查制度,早期发现、早期治疗ROP,可改善ROP的预后。     

223例早产儿视网膜病筛查回顾性分析

目的总结早产儿视网膜病(ROP)的临床高危因素以提高防治水平。方法回顾性分析223例早产儿ROP筛查结果,以ROP为观察组,非ROP为对照组,进行统计学分析。结果 ROP发生率18.39%(41/232),胎龄及出生体质量与ROP发生率成反比;吸氧时间、最高血氧分压、最低血氧分压、呼吸暂停、支气管肺发育不良、肺泡表面活性物质应用、贫血、输血、光疗、败血症与ROP发生相关(P<0.05)。结论 ROP的发生与小胎龄、低出生体质量、氧疗、贫血、感染、光疗等多种高危因素有关。预防早产,规范用氧,积极治疗并发症,重视ROP筛查是防治ROP的关键。     

早产儿视网膜病高危因素及治疗随访分析

目的研究早产儿视网膜病(ROP)的患病率、高危因素、治疗及随访预后. 方法对1996～2000年5年中住院的568例早产儿常规行眼底检查至生后6个月,发现ROP者密切随访追踪,Ⅲ期阈值以上者行激光或冷凝手术治疗.结果检出ROP患儿46例(8.1%),其中23例(50.0%)病变逐渐稳定并恢复正常;8例(17.4%)病情进展恶化需手术治疗;8例(17.4%)有持续局限性病变,视力明显受损;3例(6.5%)失明,4 例失访.高危因素分别为低出生体重、小孕周、长期或高浓度氧疗以及早期严重贫血.结论 ROP严重影响早产儿远期生存质量,建议对所有早产儿及有高危因素的新生儿常规行眼底检查,以早期发现ROP并给予适当治疗及随访.     

早产儿视网膜病筛查随访及近期转归

目的研究住院、出院期间早产儿视网膜血管化和早产儿视网膜病(ROP)的发生情况。方法采用前瞻性研究,对2009-09-01—2010-08-31在广东省妇幼保健院、深圳市妇幼保健院、佛山市妇幼保健院出生或收治的出生体重<2000g的早产儿和低体重儿进行ROP筛查和随访。结果 (1)完成随访586例,其中ROP60例,占完成随访总数的10.2%;需治疗ROP30例,占完成随访总数的5.1%,其中出院后发现6例,占需治疗ROP患者总数的20%;出生体重<1000g、1000～<1500g、1500～<2000g组中ROP发生率分别为54.5%、16.8%、4.3%,需治疗的ROP发生率分别为45.5%、7.9%、1.3%;出生胎龄<28周、28～<32周、≥32周组中ROP发生率分别为63.2%、14.4%、5.2%,需治疗的ROP发生率分别为42.1%、8.5%、1.4%,所有研究对象无Ⅳ期或Ⅴ期病变发生。(2)526例视网膜完全血管化,住院期间视网膜完全血管化62例(11.8%),出院后视网膜完全血管化464例(88.2%)。(3)家长对ROP的进展情况和严重性认识不足,出院患者中有23.0%需电话催促复查眼底;转运患者基本要求回救治单位复诊。结论 ROP高危人群出院后视网膜完全血管化所占比例很高,仍会发生ROP,应强调出院后随访;通过及时发现和治疗,不同胎龄和出生体重的ROP病变近期预后均良好。     

进一步完善早产儿视网膜病的筛查制度

早产儿视网膜病(ROP)是儿童致盲的重要原因,已成为发展中国家日益突出的医疗和社会问题。防治ROP的关键是建立科学的筛查制度。文章主要讲述筛查制度中所涉及的筛查对象、筛查时机、随访方案等,以及如何管理该制度,以期对所有符合标准的早产儿做到一个不漏地筛查和全程随访,从而做到早期诊断和及时治疗,以降低致盲率。     

Use of digital retinal imaging in screening for retinopathy of prematurity

The frequency of premature births is increasing world‐wide. This factor, combined with improved survival and revised screening criteria, is resulting in an increased workload in screening for retinopathy of prematurity. Digital retinal imaging is emerging as an important alternative tool for diagnosing retinopathy of prematurity, and its use has even been extended to developing countries. Neonatal nurses and technicians can be trained to use digital imaging devices effectively. This is important in areas that do not have ready access to paediatric ophthalmologists. The ability to transfer images electronically makes it a valuable tool in telemedicine, while the ability to store and retrieve images is also advantageous from a medico‐legal perspective. Image analysis software can further improve the accuracy of diagnosis. The main limitation of this technology is its high capital cost.     

Screening for retinopathy of prematurity in developing countries

Improved survival of low birth weight, premature babies in India has increased the incidence of retinopathy of prematurity. Western reports describe screening criteria to pick up babies most at risk. However, our population of at-risk neonates is likely to be different, as most nurseries in India are not very well equipped. Our aim was to develop a screening strategy appropriate for our conditions. Ophthalmic records of 60 neonates with gestational age < or =35 weeks and/or birth weight < or =1500 g, born over a 1-year period, were retrospectively reviewed. Laterality, location and stage of retinopathy of prematurity were recorded. Age at detection, at threshold disease and at maximum stage was recorded, and progression or regression of retinopathy noted. The incidence of retinopathy was 13/60 (21.7%) and of threshold disease was 3/60 (5.0%). Threshold disease was never seen before 5.5 weeks PNA. Zone I disease invariably, zone II disease in 12.5% cases and zone III disease never progressed to threshold stage. Most (10/13; 76.9%) cases regressed without treatment. Screening for retinopathy should commence at 4 weeks PNA (post-neonatal age). Screening time, discomfort to the baby and complications can be reduced by examining temporal retina first. If normal, the nasal retina need not be examined. Also, babies with zone III disease need not be followed up to complete visualization. Retinal vascular dilatation, resistance to pupillary dilation and persistence of tunica vasculosa lentis can be indicators of intensive screening.     

切实加强对早产儿视网膜病的防治

早产儿视网膜病(ROP)是儿童致盲的重要原因之一,我国每年约有100万早产儿面临发生ROP的危险,目前对ROP的防治工作还不够规范和完善,切实加强对ROP的防治非常重要。以下3个方面是防治ROP的关键环节:通过积极预防,降低ROP发生率;通过早期诊断,及时发现ROP;通过及时治疗,降低ROP致盲率。     

Pathogenesis of retinopathy of prematurity

Retinopathy of prematurity (ROP) is a blinding disease, initiated by delayed retinal vascular growth after premature birth. There are both oxygen-regulated and non-oxygen-regulated factors, which contribute to both normal vascular development and retinal neovascularization. One important oxygen-regulated factor, critical to both phases of ROP, is vascular endothelial growth factor (VEGF). A critical non oxygen-regulated growth factor is insulin-like growth factor (IGF-1). In knockout mice, lack of IGF-1 prevents normal retinal vascular growth, despite the presence of VEGF, important to vessel development. In vitro , low IGF-1 prevents vascular endothelial growth factor-induced activation of Akt, a kinase critical for vascular endothelial cell survival. Premature infants who develop ROP have lower levels of serum IGF-1 than age-matched infants without disease.
Conclusion : IGF-1 is critical to normal vascular development. Low IGF-1 predicts ROP and restoration of IGF-1 to normal levels may prevent ROP.     

Perinatal factors associated with retinopathy of prematurity

The etiology of retinopathy of prematurity appears to be multifactorial. Introduction of new treatments in neonatal care may add new risk factors. We have analyzed thc relationship between 42 perinatal factors and the development of retinopathy of prematurity in 78 infants with a birth weight < 1501 g and/or gestational age < 33 weeks. We have also applied a chronological analysis of the maximum and minimum pO₂ and pCO₂ values. Retinopathy of prematurity was seen in 37 of 78 infants (47.4%)). Nineteen factors were found to be related to the development of retinopathy of prematurity. However, when step-wise logistic regression analysis was used, only birth weight, number of days of oxygen therapy and use of beta-blocking agents by the mother before birth were found to be associated with the development of retinopathy or prematurity. The results suggest that medication with beta blockers immediately before birth should be used cautiously.     

Perinatal factors associated with retinopathy of prematurity

The etiology of retinopathy of prematurity appears to be multifactorial. Introduction of new treatments in neonatal care may add new risk factors. We have analyzed thc relationship between 42 perinatal factors and the development of retinopathy of prematurity in 78 infants with a birth weight < 1501 g and/or gestational age < 33 weeks. We have also applied a chronological analysis of the maximum and minimum pO₂ and pCO₂ values. Retinopathy of prematurity was seen in 37 of 78 infants (47.4%). Nineteen factors were found to be related to the development of retinopathy of prematurity. However, when step-wise logistic regression analysis was used, only birth weight, number of days of oxygen therapy and use of beta-blocking agents by the mother before birth were found to be associated with the development of retinopathy or prematurity. The results suggest that medication with beta blockers immediately before birth should be used cautiously.     

Regressed retinopathy of prematurity: the relationship between clinical risk factors of the newborn period and regressed retinopathy of prematurity severity in a preterm born population of Stockholm county 1976-81

In a retrospective study, clinical risk factors of the neonatal period were correlated with the severity of regressed retinopathy of prematurity (ROP) in a population of preterm infants (bw less than 1500 g and or gestational age less than 33 weeks). At the age of 5-11 years 134 out of 528 preterm born infants (25.4%) were found to be under ophthalmic care. Reliable information on eye fundus status could be obtained in 105 of them. Regressed ROP was found in 61, the moderate form in 48 (9.1%) and the severe form in 13 (2.5%) patients. Twelve patients (2.3%) had visual acuity of less than 0.3 on the worst eye and two (0.4%) of these patients were blind from ROP. Twenty-four clinical factors of the newborn period were correlated with the severity of regressed ROP. The results suggest that long oxygen exposure in combination with other factors interfering with retinal vasotonus are associated with the degree of the disease developed.     

早产儿视网膜病的手术治疗

早产儿视网膜病(retinopathy of prematurity,ROP)是儿童重要的可预防的致盲性疾病,需早期发现、及时治疗,对于阈值期及阈值前1型病变首选激光光凝治疗,如果进展为视网膜脱离需进行巩膜扣带术或玻璃体手术,文章对ROP手术治疗的现状及进展进行评述。