目的:对单胎和多胎新生儿早产儿视网膜病变(ROP)的危险因素进行对比分析。
方法:在对521例早产儿的回顾性评估中,包括单身人士,双胞胎,和出生在34周胎龄或之前出生的三胞胎,出生体重低于2000克,并且完成了ROP筛查计划,2020年至2023年,在设拉子医科大学附属的门诊转诊ROP筛查诊所,包括在内。符合资格标准的新生儿从28天龄开始纳入筛查计划,并根据国家ROP筛查指南随访至出院或治疗。ROP严重性数据,结果,治疗方式,和风险因素,包括胎龄(GA),出生体重(BW),性别,新生儿重症监护病房(NICU)的住院时间,氧气补充,机械通气,输血,交货方法,孕产妇和新生儿的合并症,从单胎和多胎中提取并比较早产新生儿。
结果:对ROP严重程度分布的分析显示238例(45.7%)低危(2型阈值前ROP或以下严重)ROP,16例(3.1%)高风险(I型阈值前ROP或更严重)ROP。根据需要治疗的新生儿ROP的危险因素的比较分析,多胎新生儿表现出明显更大的GA(27.50±3.27vs.30.00±2.00vs.31.14±0.38周,对于单身人士,p=0.032,双胞胎和三胞胎,分别);BW更大(861.67±274.62vs.1233.33±347.75vs.1537.14±208.86g,p=0.002);NICU住院时间较短(60.17±21.36vs.34.00±12.17vs.12.00±6.32天,p=0.001)和氧气补充(47.33±16.57vs.36.00±8.49vs.4.60±2.41天,p=0.001)。在其他危险因素的患病率方面,单胎新生儿和多胎新生儿之间没有显着差异。与单胎相比,无ROP和低风险ROP的多胎新生儿的GA和BW明显较低(p<0.001)。
结论:与单胎新生儿相比,多胎新生儿可能发展为高危ROP,需要在更大的胎龄和出生体重以及更低的氧气补充持续时间和NICU入住时间进行治疗。这种模式促使人们重新评估筛查标准,提示在筛查计划中可能需要考虑传统危险因素较低的多胎新生儿。这种模式应该在更大的多胎早产儿人群中进一步评估。
OBJECTIVE: To conduct a comparative analysis of risk factors for retinopathy of prematurity (ROP) in single- and multiple-born neonates.
METHODS: In a retrospective evaluation of 521 premature neonates, encompassing singletons, twins, and triplets born at or before 34 weeks of gestational age with a birthweight of less than 2000 g and who completed the ROP screening program, between 2020 and 2023, in outpatient referral ROP screening clinic affiliated by Shiraz University of Medical Sciences, were included. Neonates with the eligibility criteria were enrolled in the screening program from 28 days old age and followed up to discharge or treatment based on national ROP screening guideline. Data on ROP severity, outcome, treatment modality, and risk factors, including gestational age (GA), birth weight (BW), sex, duration of neonatal intensive care unit (NICU) admission, oxygen supplementation, mechanical ventilation, blood transfusion, method of delivery, and maternal and neonatal comorbidities, were extracted and compared between premature neonates from singleton and multiple births.
RESULTS: The analysis of the ROP severity distribution revealed 238 neonates (45.7%) with low-risk (type 2 prethreshold ROP or less severe) ROP and 16 (3.1%) with high-risk (type I prethreshold ROP or more severe) ROP who underwent treatment. According to the comparative analysis of risk factors in neonates with ROP requiring treatment, multiple birth neonates exhibited significantly greater GA (27.50 ± 3.27 vs. 30.00 ± 2.00 vs. 31.14 ± 0.38 weeks, p = 0.032 for singletons, twins and triplets, respectively); greater BW (861.67 ± 274.62 vs. 1233.33 ± 347.75 vs. 1537.14 ± 208.86 g, p = 0.002); and shorter duration of NICU admission (60.17 ± 21.36 vs. 34.00 ± 12.17 vs. 12.00 ± 6.32 days, p = 0.001) and oxygen supplementation (47.33 ± 16.57 vs. 36.00 ± 8.49 vs. 4.60 ± 2.41 days, p = 0.001). There was no significant difference between single-born neonates and multiple-born neonates regarding the prevalence of other risk factors. Multiple-born neonates with no ROP and low risk ROP showed significantly lower GA and BW compared to singletons (p < 0.001).
CONCLUSIONS: Multiple gestation neonates may develop high-risk ROP requiring treatment at a greater gestational age and birth weight and at a lower duration of oxygen supplementation and NICU admission compared to the single birth neonates. This pattern prompts a reevaluation of screening criteria, suggesting a potential need to consider multiple birth neonates with lower traditional risk factors in screening programs. This pattern should be further evaluated in larger populations of multiple born premature neonates.