背景:早产儿视网膜病变(ROP),是婴儿失明的可预防的主要原因,并且是未成熟视网膜经历异常血管生长的病症。ROP的发展是多因素的;然而,风险因素存在争议。本研究旨在确定伊朗ROP发展时间的风险因素。
方法:这项历史队列研究利用了Farabi医院ROP部门转诊的所有新生儿的医院记录(2017年至2021年)和Mahdieh医院转诊给Farabi医院的婴儿NICU记录的数据。出生体重(BW)≤2000g或胎龄(GA)<34周的早产儿,以及临床过程不稳定的选定婴儿,根据他们的儿科医生或新生儿学家的判断,BW>2000g或GA≥34周。结果变量是ROP发展的时间(周)。随机生存森林用于分析数据。
结果:共338例,包括676只眼睛,进行了评估。研究组的平均GA和BW分别为31.59±2.39周和1656.72±453.80g,分别。根据最小深度和可变重要性的标准,ROP发展时间的最重要预测因素是通气持续时间,GA,氧气补充的持续时间,胆红素水平,抗生素给药的持续时间,总胃肠外营养(TPN)的持续时间,母亲年龄,出生顺序,表面活性剂给药次数,及时筛选。拟合模型预测生存的一致性指数为0.878。
结论:我们的研究结果表明,通气时间,GA,氧气补充的持续时间,胆红素水平,抗生素给药的持续时间,TPN的持续时间,母亲年龄,出生顺序,表面活性剂给药次数,及时筛查是影响ROP预后的潜在危险因素。已识别的风险因素之间的关联大多是非线性的。因此,建议在管理治疗和设计早期干预措施时考虑这些关系的性质.
BACKGROUND: Retinopathy of prematurity (ROP), is a preventable leading cause of blindness in infants and is a condition in which the immature retina experiences abnormal blood vessel growth. The development of ROP is multifactorial; nevertheless, the risk factors are controversial. This study aimed to identify risk factors of time to development of ROP in Iran.
METHODS: This historical cohort study utilized data from the hospital records of all newborns referred to the ROP department of Farabi Hospital (from 2017 to 2021) and the NICU records of infants referred from Mahdieh Hospital to Farabi Hospital. Preterm infants with birth weight (BW) ≤ 2000 g or gestational age (GA) < 34 wk, as well as selected infants with an unstable clinical course, as determined by their pediatricians or neonatologists, with BW > 2000 g or GA ≥ 34 wk. The outcome variable was the time to development of ROP (in weeks). Random survival forest was used to analyze the data.
RESULTS: A total of 338 cases, including 676 eyes, were evaluated. The mean GA and BW of the study group were 31.59 ± 2.39 weeks and 1656.72 ± 453.80 g, respectively. According to the criteria of minimal depth and variable importance, the most significant predictors of the time to development of ROP were duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of Total Parenteral Nutrition (TPN), mother age, birth order, number of surfactant administration, and on time screening. The concordance index for predicting survival of the fitted model was 0.878.
CONCLUSIONS: Our findings indicated that the duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of TPN, mother age, birth order, number of surfactant administrations, and on time screening are potential risk factors of prognosis of ROP. The associations between identified risk factors were mostly nonlinear. Therefore, it is recommended to consider the nature of these relationships in managing treatment and designing early interventions.