背景:早产儿视网膜病(ROP)是一种影响妊娠30周以下早产儿的疾病。ROP的病理生理学涉及最初的血管闭塞期,随后是导致疾病进展的血管增殖期。在ROP的血管增殖期使用补充氧气与疾病进展减少有关。但这如何影响ROP治疗的需要尚不清楚.这项研究的目的是比较2期ROP早产儿实施新的补充氧疗方案后激光或玻璃体内贝伐单抗的比率。
方法:这是2017年1月至2022年12月12日在莱利儿童医院诊断为2期ROP的早产儿的回顾性图表回顾。在2017年1月至2020年6月之间诊断的患者被归类为队列A,预协议实现。2020年8月至2022年12月12日确诊的患者被归类为队列B,后协议实施。在队列A中,在整个住院期间,血氧饱和度保持在91-95%.在队列B中,诊断为2期ROP后,氧饱和度增加至97-99%.使用卡方和学生T检验进行统计分析,然后进行多变量分析以确定氧气方案对ROP治疗需求的影响.
结果:在2017年1月至2022年12月期间,共有211例患者被诊断为2期ROP。这些病人中,122人在方案实施治疗之前(队列A),89人在实施补充氧气方案(队列B)后。B组的妊娠年龄稍高(A组25.3±1.9,B组25.8±1.84,p=0.04)。出生体重没有差异,NEC,BPD,或生存。队列B在住院期间对有创机械通气的需求较少,而CPAP的天数较高。值得注意的是,队列A中有67名(55%)患者接受激光光凝或玻璃体内贝伐单抗治疗,而队列B中有20名(22%)患者接受治疗(OR0.19,0.08-0.40)。
结论:在接受补充氧气方案治疗的高危患者中,激光光凝或玻璃体内贝伐单抗的需求显著降低。这一结果支持了这样的想法,即有针对性的补充氧气疗法将饱和度保持在97%至99%之间,可以减少2期ROP婴儿的疾病进展,并可能减少额外程序的负担。
BACKGROUND: Retinopathy of prematurity (ROP) is a disease that affects preterm infants born younger than 30 weeks of gestation. The pathophysiology of ROP involves an initial vaso-obliterative phase followed by vaso-proliferative phase that leads to disease progression. The use of supplemental oxygen during the vaso-proliferative phase of ROP has been associated with reduced disease progression, but how this impacts the need for ROP treatment is unclear. The goal of this study was to compare the rate of laser or intravitreal bevacizumab after implementation of a new supplemental oxygen therapy protocol in preterm infants with stage 2 ROP.
METHODS: This is a retrospective chart review of preterm infants diagnosed with stage 2 ROP at Riley Hospital for Children between 1/2017 and 12/2022. Patients diagnosed between 1/2017 and 6/2020 were classified as Cohort A, preprotocol implementation. Patients diagnosed from 8/2020 to 12/2022 were classified as Cohort B, postprotocol implementation. In Cohort A, oxygen saturation was kept at 91-95% through the entire hospitalization. In Cohort B, oxygen saturation was increased to 97-99% as soon as Stage 2 ROP was diagnosed. Statistical analyses were performed using chi-square and Student\'s T test, followed by multivariate analyses to determine the impact of the oxygen protocol on the need for ROP treatment.
RESULTS: A total of 211 patients were diagnosed with stage 2 ROP between 1/2017 and 12/2022. Of those patients, 122 were before protocol implementation therapy (Cohort A), and 89 were after implementation of supplemental oxygen protocol (Cohort B). Gestational age was slightly higher in Cohort B (Cohort A 25.3 ± 1.9, Cohort B 25.8 ± 1.84, p = 0.04). There was no difference in birth weight, NEC, BPD, or survival. Cohort B had lesser need for invasive mechanical ventilation and higher days on CPAP during hospitalization. Notably, Cohort A had 67 (55%) patients treated with laser photocoagulation or intravitreal bevacizumab versus 20 (22%) patients in Cohort B (OR 0.19, 0.08-0.40).
CONCLUSIONS: The need for laser photocoagulation or intravitreal bevacizumab was significantly decreased in high-risk patients treated with the supplemental oxygen protocol. This result supports the idea that targeted supplemental oxygen therapy to keep saturations between 97 and 99% can reduce disease progression in infants with stage 2 ROP and potentially decrease the burden of additional procedures.