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.     

床旁激光治疗早产儿视网膜病变的疗效分析

目的：探讨床旁激光治疗早产儿视网膜病变（ROP）的临床效果。方法：回顾性分析2009年3月至2009年8月在我院新生儿重症监护室（NICU）内床旁激光治疗的30例ROP患儿的临床资料。结果：30例ROP患儿中59只眼接受了激光治疗,总体治愈率95%。根据ROP国际分类标准,30例ROP患儿中,Ⅰ区病变有13例（26眼）,Ⅱ区病变有17例（33眼）。Ⅰ区病变组平均出生胎龄、体重及治疗时纠正胎龄均明显低于Ⅱ区病变组,而激光斑点数量明显高于Ⅱ区病变组。Ⅱ区病变组治愈率（100%）明显高于Ⅰ 区病变组（88%）（P<0.05）。结论：NICU床边激光手术治疗Ⅰ区病变和Ⅱ区病变是有效的。与Ⅱ区病变相比,Ⅰ区病变患儿预后相对较差。［中国当代儿科杂志,2010,12（9）：696-699］     

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］     

视觉诱发电位在早产儿视网膜病变中的应用研究

目的探讨闪光刺激视觉诱发电位(F-VEP)与早产儿视网膜病变(ROP)的关系。方法2003-01—2006-01对东南大学医学院附属盐城医院儿科采用国际标准法对早产儿对照组33例(66眼)和ROP组36例(72眼)行F-VEP检测,并进行分析。结果P100波潜伏期随眼底病变程度的加重有逐渐延长的趋势,与对照组比较差异有显著性(F=43.5,P<0.001);P100波波幅比较ROP轻度组与对照组差异无显著性(P>0.05),不同程度的ROP各组间的P100波潜伏期及波幅比较差异有显著性(P<0.05);P100波潜伏期与ROP的程度有显著相关性(r=0.648,P<0.05)。结论F-VEP检查可以作为ROP发生和发展过程中的重要监测方法。     

雷珠单抗治疗早产儿视网膜病变研究进展

<正>尽管激光治疗是目前早产儿视网膜病变(retinopathy of prematurity,ROP)最常用的治疗方法,但它并不适用于治疗所有类型的ROP,尤其对于1区病变ROP及急进性后部型ROP(AP-ROP),激光治疗往往难以实施或带来严重不良后果[1]。随着对ROP发病机制的不断深入认识,有越来越多的药物开发应用于ROP,ROP治疗已逐步迈进药物治疗时代。血管内皮生长因子(VEGF)在ROP发生     

早产儿视网膜病变与吸氧的关系分析

早产儿视网膜病变(retinopathy of prematuritv,ROP)，以往曾被称为晶体后纤维增生症。这是一种因视网膜血管异常增殖而导致幼儿视力严重丧失的疾病，绝大多数发生于低体重的早产儿。近年来，随着医疗技术的发展，越来越多的低体重早产儿得以存活，故该病的发病率也呈上升趋势。现将我院门诊2002～2004年诊治的14例患儿的临床情况分析如下。     

胰岛素样生长因子-Ⅰ与早产儿视网膜病变的研究

早产儿视网膜病变(retinopathy ofprematurity,ROP)可造成早产儿严重视力障碍.是导致全球儿童双目失明的第五大原因.大多数学者认为此病是可以预防的,因此探索BOP的发病机制成为当今医学界的一个研究热点.近年来,研究表明胰岛素样生长因子-Ⅰ(insulin-like growth factor-Ⅰ,IGF-Ⅰ)在新血管形成中作为血管内皮生长因子(vascular endothelial growth factor,VEGF)的正向调节因子,起到重要作用.IGF-Ⅰ通过与其受体结合激活信号传导级联反应,激活VEGF诱导新血管形成.通过对IGF-Ⅰ系统的研究发现,对IGF-Ⅰ及其调节因子的干预,可能是预防BOP的一种有效的新方法.     

中国大陆早产儿视网膜病变临床特点和眼底病变的多中心调查

目的通过多中心筛查反映中国大陆早产儿视网膜病变(ROP)的发生率及相关流行病学特征。方法 2010年6月1日至2012年6月1日ROP调查协作组在中国大陆7个行政区域首先邀请有能力行ROP筛查的医院,从新生儿生后第4周或纠正胎龄32周行初次眼底检查,使用统一型号的间接眼底镜和电子眼底镜,依据ROP分期决定随访方案,经复旦大学附属眼耳鼻喉科医院培训、考核认证的ROP筛查医生,参照ROP国际分类法诊断和分期。结果中国7个行政区共22家医院6 091例出生体重2 000 g或胎龄34周的早产儿或因重大疾病进行了氧疗(≥5 d)的新生儿中,ROP924例,发生率为15.2%。轻度ROP(1和2期)92.3%(853/924),重度ROP(3期及以上)7.7%(71/924),急进型ROP患儿7例。行激光或手术治疗69例,均为ROP 3期以上病例。924例ROP患儿胎龄28~36+5(30.2±2.2)周,出生体重624~3 400(1 364±344)g。呈现出生体重越低和出生胎龄越小ROP发生率逐渐增高趋势,出生体重越低和出生胎龄越小轻度ROP的发生率未见逐渐增高的趋势。ROP 4~5期仅出现在出生胎龄30周和出生体重1 250 g的新生儿。妇幼保健院较儿童专科医院和综合性医院儿科ROP发生率低,但重度ROP发生率高。结论中国大陆ROP发生率为15.2%,出生胎龄30周ROP发生率为46.9%,出生体重1 500 g ROP发生率为30.6%。     

早产儿视网膜病变患儿血清谷氨酸水平变化的意义及其对预后的影响

目的探讨早产儿视网膜病变(ROP)患儿血清谷氨酸水平与病情严重程度之间的关系及其对预后的影响。方法选取2017年6月至2018年6月在河南省立眼科医院筛查并诊治的92例ROP患儿及同期河南省立眼科医院筛查的50例健康早产儿(对照组)进行临床对照研究,92例ROP患儿根据病变分期分为轻度ROP组和重度ROP组,依据病情进展与否分为自然消退组和病情进展组,通过测定各组儿童出生1周和出生6周血清谷氨酸水平,分析其与ROP病情严重程度的关系及其对预后评估的意义。结果重度ROP组患儿出生1周血清谷氨酸水平[(122.08±14.55)mmol/L]和出生6周血清谷氨酸水平[(107.13±13.20)mmol/L]最高,轻度ROP组患儿次之[分别为(98.60±14.48)mmol/L、(85.41±14.49)mmol/L],对照组患儿最低[分别为(68.52±7.69)mmol/L、(54.97±6.31)mmol/L],3组比较差异有统计学意义(均P<0.05);Pearson相关性分析提示出生1周和出生6周血清谷氨酸水平均与ROP病情严重程度均呈正相关(r=0.869、0.875,均P<0.05)。病情进展组患儿出生1周及出生6周血清谷氨酸水平[(107.18±17.62)mmol/L、(92.94±16.21)mmol/L]均显著高于自然消退组患儿[(131.53±10.22)mmol/L、(118.82±8.18)mmol/L],2组间比较差异均有统计学意义(均P<0.05)。出生1周和出生6周血清谷氨酸水平预测ROP病情进展患儿受试者工作特征曲线(ROC)下面积分别为0.855、0.936,根据ROC曲线结果,分别确定出生1周和出生6周血清谷氨酸水平最佳临界值分别为117.83 mmol/L(敏感性为0.909,特异性为0.728)、106.69 ng/L(敏感性为1.000,特异性为0.790)。结论出生1周和出生6周血清谷氨酸水平与ROP患儿病情严重程度呈正相关,同时出生1周和出生6周血清谷氨酸水平最佳临界值预测患儿疾病进展的敏感性和特异性均较高,对患儿预后评估具有较高的价值。     

促血管生成素-1与早产儿视网膜病变的研究进展

早产儿视网膜病变的特征是视网膜血管发育异常、新生血管形成、纤维增殖及视网膜脱离,可导致包括终生失明以及多种严重并发症.促血管生成素-1是影响血管生成的重要因子,与早产儿视网膜病变的发生有密切关系.该文就Ang-1与早产儿视网膜病变的关系作一综述.     

Blood metabolites in preterm infants with retinopathy of prematurity based on tandem mass spectrometry: a preliminary study北大核心CSCD

目的应用液相色谱-串联质谱技术(liquid chromatography tandem mass spectrometry,LC-MS/MS)和代谢组学方法探讨早产儿视网膜病(retinopathy of prematurity,ROP)患儿出生血代谢产物差异,寻找ROP早期诊断的新的生物标记物。方法收集2013年1月—2016年12月中山大学附属第六医院住院的21例ROP患儿(ROP组)及同期21例非ROP患儿(非ROP组)干血片标本,利用LC-MS/MS进行代谢产物测定,运用正交偏最小二乘判别分析法(orthogonal partial least squares discriminant analysis,OPLS-DA)寻找差异物质和生物标记物。结果ROP组和非ROP组患儿血代谢谱有明显差异,经模式识别分析、代谢物得分图(Score-plot,S-plot)、权重分析初步得出10个差异较大的氨基酸。进一步统计分析发现ROP组患儿血谷氨酸、亮氨酸、天冬氨酸、鸟氨酸和甘氨酸水平明显高于非ROP组,差异有统计学意义(P<0.05)。受试者工作特征曲线分析显示,谷氨酸及鸟氨酸对ROP诊断价值最高。结论ROP患儿与非ROP患儿比较血代谢产物具有明显差异,谷氨酸及鸟氨酸是诊断ROP的代谢标志物。LC-MS/MS结合代谢组学分析方法在ROP早期识别与诊断中具有潜在的应用价值。     

携带血管生成素1基因的骨髓间充质干细胞对早产儿视网膜病模型小鼠的干预研究

目的探讨携带血管生成素1(Ang-1)基因的骨髓间充质干细胞(BMSCs)对氧诱导视网膜病模型小鼠视网膜新生血管的作用。方法将出生7天的昆明小鼠随机分成空气对照组和高氧模型组(其中包括注射Ang-1+BMSCs组、单纯BMSCs组及高氧PBS组),每个亚组12只。除空气对照组之外,其余组均放入氧分压65%±5%的氧箱内饲养5天后取出。将携带Ang-1的BMSCs和不携带Ang-1的BMSCs各2 ml(内含细胞总数为1×105)在鼠龄第7、12、17日分别腹腔注入高氧模型组中的Ang-1+BMSCs组和单纯BMSCs组小鼠体内,空气对照组和高氧PBS组注入相同剂量的PBS缓冲液。于鼠龄17天时取小鼠眼球做标本固定,分别用免疫组织化学法检测Ang-1蛋白、qRT-PCR法检测Ang-1蛋白mRNA、计数突破视网膜内界膜的血管内皮细胞数及明胶墨汁灌注眼底视网膜血管,比较小鼠视网膜新生血管情况。结果高氧模型各组每只眼球均可见突出内界膜的新生血管内皮细胞。其中Ang-1+BMSCs组、单纯BMSCs组与高氧PBS组相比较,突破视网膜内界膜的血管内皮细胞核明显减少,差异有统计学意义(P<0.05);与高氧PBS组比较,Ang-1+BMSCs组及单纯BMSCs组血管走形较直,Ang-1蛋白表达量增加,免疫组织化学染色被黄染的胞浆较丰富;Ang-1+BMSCs组与单纯BMSCs组相比,前者血管走行较直,周边新生血管覆盖率降低,突破内界膜新生血管细胞数目减少,Ang-1蛋白的表达量增多。结论高氧能诱导新生鼠视网膜新生血管生成;Ang-1基因与BMSCs结合与单纯应用BMSCs相比,前者能更有效地改善视网膜新生血管的增生状况。     

Home oxygen therapy in infants with bronchopulmonary dysplasia: a prospective study

We followed the clinical course of 21 infants with bronchopulmonary dysplasia enrolled in a prospective home O₂ therapy programme during a 4-year-period. Mean gestational age was 28.5 weeks (range, 25–36 weeks) and mean birth weight 1093 g (range 630–2750 g). Infants were regularly monitored to maintain pulse oximeter O₂ saturation over 94%–95%. The source of O₂ was liquid oxygen and was delivered by nasal cannula. During the follow up oxygenation was assessed by SatO₂ measurement, cardiac function by Doppler echocardiography and respiratory function by the occlusion technique. All patients had an ophthalmological follow up. The mean age of the infants at discharge was 3.7 months (range 1.7–8.6) and mean weight 2830 g (range 2150–3780 g). At discharge 8 infants had right ventricular hypertrophy (RVH) and four of them had pulmonary hypertension. Mean duration of home O₂ therapy was 97 days (range 15–320 days) and the mean age of discontinuation of O₂ was 6.9 months (range 3–14.7 months). The cardiological follow up was benign: the ECG signs of RVH disappeared by 12 months of age in six out of eight infants and the right ventricular pulmonary pressure, as measured by the Doppler method, normalised in the four patients in whom it was detected. No relationship was found between respiratory mechanics and the duration of O₂ therapy. Weight gain was poor with mean growth at the 3rd percentile for females and just below the 3rd percentile for males. Twelve of the 21 infants required 25 rehospitalizations. No one presented deterioration of retinopathy of prematurity that was present in 16 infants at discharge; at 12 months retinopathy was resolved in 14 infants. A total of 2025 hospital days were saved, representing a significant financial saving. Conclusion Home O₂ therapy permits the safe early discharge of O₂-dependent BPD infants and it reduces significantly the length of time spent in hospital which represents a considerable financial saving. Received: 17 December 1996 and in revised from: 15 April 1997 / Accepted: 29 April 1997     

早产儿视网膜病血清血管内皮生长因子色素上皮衍生因子的检测和临床意义

目的 观察早产儿生后血清血管内皮生长因子（VEGF）和色素上皮衍生因子（PEDF）水平的动态变化，为早期诊断及预测早产儿视网膜病(ROP)提供依据。方法 从2006年6月至2007年1月复旦大学附属儿科医院新生儿病房的早产儿中按入选标准和排除标准确认研究对象。将出生体重≤2 000 g或胎龄≤34周的患儿进行ROP筛查，将发生ROP患儿作为ROP组；选取与ROP组胎龄和出生体重相匹配的早产儿作为ROP对照组。将未发生ROP的早产儿根据胎龄分为<32周，~33+6周和~36+6周3个胎龄组。所有入选早产儿生后第7、14、21、28和35天分别进行采血，分离血清，经ELISA法检测血清VEGF和PEDF的水平。采用SPSS 13.0中混合线性模型 重复数据测量、相关性分析、t检验和单变量方差分析法进行数据分析。结果 入选的早产儿共170例，其中6例在生后14 d内自动出院失访而排除，11例发生ROP。未发生ROP的153例早产儿中，<32周54例，~33+6周48例，~36+6周51例。各胎龄组血清VEGF水平随日龄的增长而下降（r=－0.167，P=0.000），与第7天比较，差异有统计学意义（第14天，P=0.010；第21天，P=0.000），而自21 d起基本保持稳定；血清PEDF水平在生后14 d内变化无统计学意义（P=0.713），14 d后随日龄的增长而升高（r=0.287，P=0.000），与第7天比较，差异有统计学意义（第21天，P=0.008；第28天，P=0.001；第35天，P=0.000）。胎龄对VEGF和PEDF水平的影响较出生体重显著，胎龄越小，生后血清VEGF和PEDF水平越高，在出生体重的协同作用下，胎龄与VEGF和PEDF水平均呈负相关（r=－0.162，P=0.027；r=－0.165，P=0.024）。早产儿生后PEDF/VEGF比值恒定，且随日龄的增长而升高（r=0.237，P=0.000）。ROP组血清VEGF（P=0.000）水平在生后21 d均较ROP对照组低，且随日龄的增长反有上升； PEDF水平随着日龄的增长未能体现上升趋势；PEDF/VEGF比值在生后第7天显著升高（P=0.036），生后35 d内随着日龄的增长反有下降（r=－0.449，P=0.047）。结论 发生ROP的早产儿血清VEGF、PEDF水平以及PEDF/VEGF比值在生后1～3周可有变化趋势的改变，提示若早产儿生后血清VEGF水平较同胎龄者低，且随着日龄的增长反有升高，PEDF水平随着日龄的增长未能升高，PEDF/VEGF比值在第7天显著升高，在生后28 d内随着日龄的增长反有下降，可能预示着ROP的发生。这可能有助于临床医生更早地预测ROP的发生，从而积极采取有效的干预措施预防和减轻ROP的发生。     

Incidence of and risk factors for neonatal morbidity after active perinatal care: extremely preterm infants study in Sweden (EXPRESS)

Aims: The aim of this study was to determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004–2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long‐term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotizing enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage ≥3. Eighty‐five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty‐seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusion: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long‐term health of survivors are warranted.     

Nasal continuous positive airway pressure and outcomes in preterm infants: A retrospective analysis

OBJECTIVE

The aim of the present retrospective study was to describe the use of nasal continuous positive airway pressure (NCPAP) and the prevalence of bronchopulmonary dysplasia (BPD).

STUDY DESIGN

Data from 1526 neonates with gestational age less than 32 weeks, admitted to Children’s and Women’s Health Centre of British Columbia (Vancouver, British Columbia) between period 1 (1996 to 2000) and period 2 (2000 to 2004) were analyzed. The use of respiratory therapies and outcomes were retrospectively compared before and after the introduction of a NCPAP approach to respiratory support.

RESULTS

A significant increase in the use of NCPAP was noted between periods 1 and 2 (60% versus 71%), as well as a significant reduction in the use of surfactant (50% versus 41%), postnatal steroids (30% versus 10%) and the need for mechanical ventilation (77% versus 64%). In period 2, there was a significant reduction in the prevalence of BPD at 28 days (33% versus 26%), higher prevalence of severe retinopathy of prematurity (3% versus 6%) and less periventricular leukomalacia (4% versus 2%).

CONCLUSIONS

A significant increase in the use of NCPAP therapy in the neonatal unit has been associated with a decrease in the use of more invasive therapies. The incidence of BPD has decreased if defined as need for supplemental oxygen at 28 days of age, but not when the 36 weeks’ postconceptional age criterion was used. NCPAP therapy may decrease the use of more invasive therapies and may improve respiratory outcomes. The impact of this intervention on nonrespiratory outcomes warrants further investigation.     

Late postnatal systemic steroids predispose to retinopathy of prematurity in very-low-birth-weight infants: a comparative study

BACKGROUND AND OBJECTIVE: Retinopathy of prematurity (ROP) develops mostly in very-low-birth-weight (VLBW) premature infants. Besides prematurity and hyperoxia, other variables have been brought up as risk factors for ROP. We aimed to search risk factors for ROP by comparing two groups of preemies, one with and the other without ROP. PATIENTS AND METHODS: During 2004-2006, 27 VLBW premature infants developed ROP (ROP group). For each neonate in the ROP group, we chose a neonate born at similar gestational age (GA) (+/-1 week) but without ROP (control group). For each neonate of both groups, we recorded demographic, maternal, gestational, intrapartum, neonatal, interventional, growth and ophthalmologic data from patients' medical records. RESULTS: Eleven of the tested variables were significantly different between the ROP and control groups in univariate analysis. However, only seven of these variables remained significantly different between groups when controlling each variable for GA: bronchopulmonary dysplasia (BPD, p=0.04), duration of hospitalization (p=0.017), high-frequency oscillatory ventilation (HFOV, p=0.033), duration of oxygen therapy (p=0.023), surfactant therapy (p=0.045), inhaled steroids (p=0.015) and systemic steroids for BPD (p=0.007). These seven significant variables were related to respiratory morbidity and interventions. Multiple stepwise logistic regression including all significant variables in the univariate analysis showed that only systemic steroids remained significantly different between groups (p=0.007, OR 5.42, 95% CI 1.60-18.34). CONCLUSION: Significantly more neonates in the ROP group received late postnatal systemic steroids as compared to controls. We speculate that steroids, by altering insulin growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF) expression, might contribute to the pathogenesis of ROP.     

Macular pigmentary changes as a sequelae of retinal hemorrhages in premature infants with retinopathy of prematurity

PURPOSE: We assess the incidence of macular changes in ROP patients with retinal hemorrhages. PATIENTS AND METHODS: The premature group consisted of 360 children born 32 weeks gestation and/or with weight below 1,500 g. We used the RetCam-120 Digital Retinal Camera to document retinal changes. RESULTS: Of the 360 premature infants 241 (67%) had no ROP, and 119 (33%) had ROP. Of the preterm infants with ROP retinal hemorrhages were found in 46 (38%) children. Of the newborns with ROP and with retinal hemorrhages, macular pigmentary changes were found in 3 (6%) patients. Of these 3 patients, the first had pre-threshold ROP, the second threshold ROP and had underwent diode laser photocoagulation, and the third patient had stage 2 ROP. In the patients with pre-threshold and threshold ROP retinal hemorrhages appeared 6 weeks after birth and macular pigmentary changes were found 6 months after birth. In the patient with stage 2 ROP hemorrhages appeared 7-8 weeks after birth and macular pigmentary changes were detected 12 months after birth. CONCLUSIONS: Although macular hemorrhages almost always resorb without complications, our study allows the assumption that retinal hemorrhages may cause macular pigmentary changes in the macula, and thus may lead to deprivation amblyopia. Our results may suggest that the presence of the macular pigmentary changes may be related to the hemorrhage and not to the specific therapy or to the disease.