目的:评估大量早产儿视网膜病变(ROP)的发生率和危险因素。
方法:单中心回顾性研究。包括2009年1月1日至2018年12月31日在卡塔尼亚Policlinico新生儿重症监护病房住院的所有早产儿。ROP阶段和位置,需要治疗,评估母婴危险因素.
结果:对898例早产的病历进行了回顾性检查(平均胎龄32.9±2.3周)。其中149例(16.6%)发生了双侧ROP(92期1,44期2和13期3);66例(7.3%)接受了双侧激光治疗。受I区ROP1影响的三例患者的六只眼睛,在最佳激光治疗后持续15天,还接受了玻璃体内注射雷珠单抗。ROP发育的危险因素是胎龄(GA)(p<0.001),出生体重(p<0.001),辅助通气持续时间(p<0.001),多胎(p=0.003),促红细胞生成素(EPO)给药(p=0.005)和小扁豆膜的持久性。决策树分析表明,胎龄是最重要的预测因素(P<0.001);次要预测因素是29-31周GA新生儿的EPO给药(p=0.001)和32-34周GA出生体重低于2090g(p<0.001);在后一组中,动脉导管未闭(PDA)是第三预测因素(p=0.043)。
结论:在我们的研究中,ROP发生率为16.6%;7.3%的患者需要激光治疗。除了众所周知的因素,例如GA和出生体重,其他因素,如辅助通气的持续时间,EPO,多胎,PDA,在调整眼科评估和随访时,应考虑细管膜的持久性。
To evaluate Retinopathy of Prematurity (ROP) rate and risk factors in a large cohort of preterm newborns.
Single center retrospective study. All preterm inborn hospitalized at the Neonatal Intensive Care Unit of the Policlinico of Catania from January 1, 2009 till December 31, 2018, were included. ROP stage and location, treatments required, maternal and infant risk factors were evaluated.
Medical records of 898 preterms were retrospectively examined (mean gestational age 32.9 ± 2.3 weeks). Of them 149 (16.6 %) developed bilateral ROP (92 stage 1, 44 stage 2 and 13 stage 3); 66 (7.3 %) received bilateral laser treatment. Six eyes of three patients affected by zone I ROP 1, with plus persistence 15 days after an optimal laser treatment, also received intravitreal ranibizumab injection. Risk factors for ROP development were gestational age (GA) (p < 0.001), birthweight (p < 0.001), assisted ventilation duration (p < 0.001), multiple birth (p = 0.003), erythropoietin (EPO) administration (p = 0.005) and persistence of tunica vasculosa lentis. The decision-tree analysis showed gestational age as the most significant predictive factor (P < 0.001); secondary predictive factors were EPO administration (p = 0.001) in newborns 29-31 weeks GA and birthweight lower than 2090 g (p < 0.001) in 32-34 weeks GA; in this latter group patent ductus arteriosus (PDA) was a tertiary predictive factor (p = 0.043).
In our study ROP incidence was 16,6 %; 7.3 % of the patients required laser treatment. Besides well-known factors, such as GA and birthweight, other factors like duration of assisted ventilation, EPO, multiple births, PDA, tunica vasculosa lentis persistence should be considered to tailor ophthalmic evaluation and follow-up.