Italian multicentre study on retinopathy of prematurity

The aim of this prospective multicentre study was to evaluate the influence of a number of perinatal factors on the development of ROP in high risk preterm infants with gestational age ≤30 weeks. All infants consecutively born in, or transferred to, one of the 14 participating centres from 1 January 1992 through 31 December 1993, who had a gestational age of 30 weeks or less and no congenital anomalies and survived to the age of 6 months, were included in the study. Of the 380 infants with mean ± SD gestational age of 28.4 ± 1.6 weeks (range 23–30 weeks) and birth weight of 1157 ± 335 g (range 485–2480 g) that were eligible for the study, 82 (21.5%) developed ROP stage 1 or 2 and 57 (15%) ROP stage 3 or 3+. Step-wise logistic regression analysis showed that the following factors had a significant predictive value for the development of ROP stage 3 or 3+: gestational age (Odds Ratio (OR)=0.6144 for each increment of 1 week of gestational age), birth weight (OR=0.843 for each increment of 100 g of birth weight), prenatal steroids (OR 4.044 for lacking or incomplete prophylaxis), RDS (OR 2.294), oxygen dependency at 60 days (OR 2.085), necrotising enterocolitis (OR 2.597). Conclusion This study confirms the role of prematurity, low birth weight and RDS in the pathogenesis of ROP, and emphasises the importance of prenatal steroid prophylaxis of RDS in very preterm infants. Furthermore, our data suggest that infants with oxygen dependency at 60 days or necrotising enterocolitis are at very high risk of developing ROP. Received: 29 September 1996 and in revised form: 28 January 1997 / Accepted: 1 April 1997     

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。     

早产儿视网膜病变筛查及相关因素分析

目的：分析我院早产儿视网膜病变( retinopathy of prematurity,ROP)的发病情况,探讨其相关因素。方法回顾性分析2013年9月至2014年9月我院新生儿科住院的182例早产儿(出生体重<2000 g或胎龄<37周)的临床资料。于生后第4~6周或纠正胎龄32周进行ROP筛查,并定期随访。结果182例早产儿中筛查出不同程度ROP患儿32例,占17.6％,其中单眼10例,双眼22例。ROP患儿平均出生胎龄为(29.3±1.5)周,平均出生体重为(1280±240)g,其中ROP 1期11例,2期5例,3期16例,附加病变5例,住院期间18例患儿行视网膜激光光凝手术,2例行Lucentis球内注射。ROP组患儿与非ROP组在出生体重、胎龄、吸氧、肺表面活性物质应用、感染、窒息、输血方面比较,差异有统计学意义(P<0.05)。 Logistic回归分析显示胎龄、吸氧、机械通气、肺表面活性物质应用对ROP的发生有明显影响( P<0.05)。结论胎龄、出生体重、吸氧、呼吸暂停、感染等因素与ROP的发生有关,出生体重及胎龄越低,ROP发病率越高。     

Recombinant human erythropoietin in the treatment of infants with anaemia of prematurity

Recombinant human erythropoietin (rHuEPO) was administered subcutaneously three times a week to 18i infants with the anaemia of prematurity at doses of 75, 150, 300, or 600 units/kg per week for 4 weeks, starting at 3–4 weeks of postnatal age. A significant and dose-dependent increase in reticulocyte count was observed from a mean baseline value of 71×10⁹/l to 200×10⁹/l after 3 weeks of therapy, compared with a change from 69 to 97×10⁹/l in 66 historical controls. The haematocrit value remained unchanged during rHuEPO treatment, whereas it steadily declined until 9 weeks of postnatal age in the controls. These effects were accompanined by a marked reduction in serum iron concentration and transferrin saturation in patients receiving standard-dose iron supplements, but not in those given larger doses. Only 3 of 18 patients required a red blood cell transfusion. These infants were among the most anaemic at entry into the study and 2 of them were unable to complete rHuEPO therapy, while the third developed iron deficiency anaemia. These data indicate that rHuEPO with appropriate iron supplementation may accelerate the recovery from anaemia of prematurity. Larger scale placebo-controiled studies are now needed to confirm these findings and verify their impact on transfusion requirements of premature infants.     

早产儿视网膜病发病机制的研究进展

早产儿视网膜病(retinopathy of prematurity,ROP)是一种与早产儿相关的眼部疾病,特点是在视网膜发育过程中血管异常的发生,重症者可引起视网膜脱离而失明,是儿童视力障碍和失明的主要原因.ROP是一个复杂的疾病,除了目前发现的吸氧、胎龄小、低出生体重、细胞因子等因素以外,促红细胞生成素、感染等因素均是可能影响本病发生的因素,根据其发病机制,早期发现、早期治疗已愈发重要,现就ROP发病机制的研究现状及进展进行综述.     

玻璃体腔内注射抗血管内皮生长因子治疗早产儿视网膜病复发的危险因素分析

目的 探讨玻璃体腔内注射抗血管内皮生长因子(vascular endothelial growth factor,VEGF)治疗早产儿视网膜病(retinopathy of prematurity,ROP)的效果及复发的危险因素。方法 回顾性收集2016年1月—2021年12月在郑州大学第一附属医院出生行抗VEGF治疗的ROP患儿159例的临床资料,根据首次抗VEGF治疗后随访周期内ROP复发与否分为复发组(24例)和非复发组(135例),比较分析2组临床资料,采用多因素logistic回归分析探讨抗VEGF治疗ROP复发的危险因素。结果 经单次抗VEGF治疗后,所有159例患儿均显示附加病变消退。24例(15.1%)抗VEGF治疗后复发,复发平均时间为治疗后(8.4±2.6)周。多因素logistic回归分析显示,术前眼底出血、总用氧时间较长是ROP复发的危险因素(P<0.05),而妊娠高血压是保护因素(P<0.05)。结论 玻璃体腔内注射抗VEGF治疗ROP是有效的。术前眼底出血和氧疗时间较长可增加ROP复发的风险,而对于妊娠高血压对ROP复发的影响,还需进一步研究证实...     

Low gestational age and chronic lung disease are synergistic risk factors for retinopathy of prematurity

Aims

This retrospective, population based study was designed to investigate risk factors for development of retinopathy of prematurity (ROP) and their possible interrelationships, in neonates of gestational age (GA) < 32 weeks born in a well-defined geographical region.

Study design—subjects

The study population included all preterm infants born alive with GA 24–32 weeks in Northwestern Greece during a 9-year period and hospitalised in the regional neonatal intensive care unit (NICU).

Outcome measurements

The association was assessed of the presence of ROP with maternal factors: age, pathology of pregnancy, in-vitro fertilisation, multiple gestation, mode of delivery, perinatal factors: gender, antenatal steroids, transportation, resuscitation, GA, birth weight (BW), small for GA status and postnatal morbidity: chronic lung disease (CLD), intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC), respiratory distress syndrome (RDS), maximum O₂ needs, hypoxic/hyperoxic episodes, patent ductus arteriosus (PDA), sepsis, using multiple logistic regression analysis.

Results

Of 189 infants without congenital anomalies born at GA 24–32 weeks ROP was diagnosed in 24 (12.7%) (> grade 2: 6). Logistic regression analysis showed ROP to be strongly associated with GA, odds ratio (OR) 2.1, confidence interval (CI) 1.3–3.3, p < 0.01 and CLD, OR 10.2, CI 2.3–44, p < 0.01, respectively, independent of confounding factors. By estimating interaction on an additive scale it was shown that the combined risk effect of GA and CLD was larger than the sum of the individual risk effects, implying synergistic effect.

Conclusions

ROP was closely and independently related to both low GA and the diagnosis of CLD, which were interrelated in the development of ROP.     

数字化视网膜照相术在早产儿视网膜病筛查中的应用

目的：评估数字化视网膜照相术（RetCam）进行眼底检查的实用性及对ROP诊断的有效率。方法：对2007年6月至2008年3月间我科收治的112例早产儿运用间接眼底镜和RetCam同时进行眼底检查,以间接眼底检查诊断ROP的结果为“金标准”,记录RetCam检查眼底结果并进行统计学分析。结果：应用RetCam共检出各期ROP 46眼,其中间接眼底镜检查证实有ROP 43眼,RetCam诊断ROP的敏感度为97.7%,特异度为98.3%,阳性预测值为93.5%,阴性预测值为99.4%,1例ROPⅠ期漏诊,RetCam与间接眼底镜对ROP诊断的一致率为97.3%。结论：RetCam是一种有效的ROP的诊断新方法,可推广应用。［中国当代儿科杂志,2010,12（10）：774-776］     

Surfactant replacement therapy: A new risk factor in developing retinopathy of prematurity?

We documented the prevalence of retinopathy of prematurity (ROP) in a group of 46 infants suffering from a moderate or severe respiratory distress syndrome and treated with surfactant replacement therapy (SRT) and 61 controls admitted in the year prior to the institution of SRT. Mortality in the treatment group was lower than in the control group (15.5% versus 23.8;P=0.29). The ROP prevalence in the treatment group was 47.8% and in the control group was 47.8% and in the control group 27.9%. To analyse the contribution of SRT alone to the prevalence of ROP, multivariate analysis using logistic regression technique was used. The odds ratio for SRT was 5.2 with a 95% confidence interval of 1.3–20.7,P=0.02. The prevalence of severe ROP in the surfactant treated group was not increased compared to the control group. From our data we conclude that SRT increases the risk of developing ROP but is not associated with more severe forms of ROP.     

Possible roles of bilirubin and breast milk in protection against retinopathy of prematurity

Aim: To explore the association of serum bilirubin level and breast milk feeding with retinopathy of prematurity (ROP) in preterm infants. Methods: We conducted a case–control study to examine the independent and combined effects of serum bilirubin and breast milk feeding on ROP risk in infants <32 weeks gestation or with birth weight <1500 g. Cases (66 infants with ROP) were matched with controls (66 infants without ROP) based on factors known to affect ROP risk. Results: When analysed using the paired t‐test, the peak bilirubin levels were lower in ROP cases than in controls (mean 7.2 vs. 7.9 mg/dL; p = 0.045). Using conditional logistic regression, we found a negative association between highest serum bilirubin level and risk of ROP (OR = 0.82 per 1‐mg/dL change in bilirubin; p = 0.06). There was no significant association between breast milk feeding and risk of ROP. Conclusion: Bilirubin may help to protect preterm infants against ROP.     

早产儿视网膜病遗传易患性及相关基因的研究进展

目前,早产儿视网膜病仍是儿童致盲和视力损害的主要原因.它是一个多因素引起的疾病,除了早产、低体重及吸氧等原因,该病也存在遗传易患性,并有大量的基因参与其发病,对于这方面的研究能深入了解早产儿视网膜病的发病机制,为防治该病提供新的临床思路.     

The apparent role of blood transfusions in the development of retinopathy of prematurity

During a 30-month-period, 184 very low birth weight infants from two Liverpool neonatal intensive care units were screened for evidence of retinopathy of prematurity (ROP). Seventeen clinical variables previously considered relevant to the development of ROP, blood gas and blood pressure data over the first 7 days, and the maximum stage of ROP reached in either eye were recorded, together with the need for cryotherapy and current visual status. Ninety-two infants developed any stage of ROP and 15 required cryotherapy or became blind. Logistic regression showed that only gestational age and frequency of blood transfusion were independently associated both with the risk of occurrence of ROP and its severity.     

早产儿视网膜病变相关因素分析

目的 探讨早产儿视网膜病变(retinopathy of prematurity,ROP)发病情况及相关危险因素.方法 回顾性分析2008年12月至2011年2月我院出生的1 356例体重2500 g以下或胎龄小于37周早产儿的临床资料,分为ROP组(n=208)和非ROP组(n=1148),分析全部早产儿自生后4～6周或矫正胎龄32周筛查眼底改变情况.结果 1356例早产儿中,208例发生ROP,发病率为15.34％,其中,严重病变36例(2.65％).与非ROP组相比,ROP组患儿在出生体重[(1 528 ±243)g vs(1 960±187)g]、胎龄[(30.92±0.72)周vs (32.87±1.28)周]、吸氧＞8d(123例vs 865例)、应用肺表面活性物质(18例vs 216例)、败血症(42例vs 154例)、宫内窘迫(63例vs 511例)、贫血(64例vs 237例)等方面比较,差异有统计学意义(P均＜0.05).Logistic回归分析结果显示出生体重、胎龄、吸氧＞8d、败血症及应用肺表面活性物质是ROP发生的高危因素(P＜0.05).同时,不同出生体重、不同胎龄患儿ROP发病率比较,差异均有统计学意义(P＜0.05).结论 出生体重及胎龄越低,ROP发病率越高,病变程度越严重.婴儿出生的成熟度越低,ROP尤其是严重ROP发病可能性越高.     

Perinatal infection, inflammation, and retinopathy of prematurity

The major known risk factors for retinopathy of prematurity (ROP) are extremely low gestational age, exposure to high levels of oxygen early after birth (phase I) and relatively lower oxygen levels later (phase II). In this review, we summarize recent data suggesting that exposure to perinatal infection/inflammation is associated with an increased risk for ROP. Part of this effect might be due to direct exposure of the developing retina to circulating products of infection and/or inflammation. Another potential mechanism that deserves exploration is that inflammation and/or oxidative stress can modify the known increased risk of oxygen-associated ROP. Taken together, accumulating evidence suggests that prenatal, perinatal, and postnatal systemic inflammation contribute to a 'pre-phase', sensitizing the pre-ROP retina for subsequent insults, setting the stage for what are now called phase I and phase II of ROP pathogenesis. Strategies targeting inflammatory responses might help reduce the risk for ROP in extremely low gestational age newborns.     

Retinopathy of prematurity: Recommendations for screening

Retinopathy of prematurity (ROP) is a disorder of the developing retinal blood vessels of the preterm infant. New recommendations for screening and treatment of ROP have been published in the past few years. Current evidence suggests that screening infants with gestational ages of 30 6/7 weeks or less (regardless of birth weight) and birth weights of 1250 g or less is a strategy with a very small likelihood that an unscreened baby would have treatable ROP. Individual centres may choose to extend birth weight screening criteria to 1500 g. Initial screening should be performed at 31 weeks' postmenstrual age in infants with gestational ages of 26 6/7 weeks or less at birth, and at four weeks' chronological age in infants with gestational ages of 27 weeks or more at birth by an ophthalmologist skilled in the detection of ROP. Follow-up examinations are conducted according to the ophthalmologist's recommendation. Infants with high-risk prethreshold ROP and threshold ROP are referred for retinal ablative therapy. Developing processes for ROP screening, documenting results and communicating results to parents as well as health professionals involved in the infant's care are important responsibilities for all nurseries providing care for preterm infants.