Mizoguchi M B, Chu T G, Murphy F M, Willits N, Morse L S
Department of Ophthalmology, University of California at Davis, Sacramento 95817, USA.
Br J Ophthalmol. 1999 Apr;83(4):425-8. doi: 10.1136/bjo.83.4.425.
To assess whether treatment of premature infants with dopamine is a risk factor for development of retinopathy of prematurity (ROP).
A retrospective case series analysis of two groups was utilised with a minimum follow up of 6 months. Clinical profiles and patient risk factors were identified along with an evaluation of ROP progression and an analysis of clinical outcome. All infants were seen in a single community neonatal intensive care unit (NICU). 41 consecutive high risk infants were identified during a 36 month period whose birth weight was less than 1000 grams and who remained in the NICU without transfer until at least 28 days of age. Dilated indirect ophthalmoscopy fundus examinations were performed on all infants to identify the degree of and progression to threshold ROP.
18 of 41 infants were treated with dopamine for hypotension. The group of infants requiring dopamine differed statistically from the non-dopamine treated group by having a slightly higher birth weight, a greater incidence of hypotension and colloid treatment, and in manifesting more advanced respiratory disease. Within the dopamine treated group, 12 of 18 infants (67%) reached prethreshold ROP and seven infants (39%) reached threshold ROP requiring laser treatment. In contrast, only three of the infants (13%) who did not require dopamine for hypotension progressed to prethreshold (p = 0.001) and only one of these infants (4%) progressed to threshold ROP (p = 0.02). Logistic regression analysis among other variables demonstrated that dopamine use and gestational age are important factors in this low birthweight population for predicting the development of threshold ROP (dopamine use: adjusted odds ratio = 119.88, p = 0.0061; gestational age: adjusted odds ratio = 0.061, p = 0.0043).
Dopamine use in low birthweight infants may therefore be a risk factor for the development of threshold ROP. More vigilant screening of high risk infants requiring dopamine therapy for systemic hypotension may be warranted.
评估用多巴胺治疗早产儿是否为早产儿视网膜病变（ROP）发生的危险因素。
采用两组回顾性病例系列分析，随访至少6个月。确定临床特征和患者危险因素，同时评估ROP进展情况并分析临床结局。所有婴儿均在单个社区新生儿重症监护病房（NICU）接受诊治。在36个月期间，确定了41例连续的高危婴儿，其出生体重小于1000克，且在NICU至少住院至28日龄未转院。对所有婴儿进行散瞳间接检眼镜眼底检查，以确定阈值ROP的程度和进展情况。
41例婴儿中有18例因低血压接受多巴胺治疗。需要多巴胺治疗的婴儿组与未用多巴胺治疗的婴儿组在统计学上存在差异，前者出生体重略高，低血压和胶体治疗发生率更高，且表现出更严重的呼吸系统疾病。在接受多巴胺治疗的婴儿组中，18例婴儿中有12例（67%）达到阈值前ROP，7例婴儿（39%）达到需要激光治疗的阈值ROP。相比之下，未因低血压需要多巴胺治疗的婴儿中只有3例（13%）进展至阈值前（p = 0.001），其中只有1例婴儿（4%）进展至阈值ROP（p = 0.02）。在其他变量中进行的逻辑回归分析表明，使用多巴胺和胎龄是该低出生体重人群中预测阈值ROP发生的重要因素（使用多巴胺：调整后的优势比 = 119.88，p = 0.0061；胎龄：调整后的优势比 = 0.061，p = 0.0043）。
因此，低出生体重婴儿使用多巴胺可能是阈值ROP发生的危险因素。对于需要多巴胺治疗全身性低血压的高危婴儿，可能需要更密切的筛查。
