Chiang Mei-Chih, Tang Jen-Ruey, Yau Kuo-Inn Tsou, Yang Chung-Mei
Department of Pediatrics, St. Martin de Porres Hospital, Chiayi, Taiwan.
Acta Paediatr Taiwan. 2002 Jul-Aug;43(4):204-7.
Retinopathy of prematurity (ROP) is one of the most important morbidity in premature infants. The latest American Academy of Pediatrics (AAP) screening guidelines for ROP are mandatory for infants with birth weights < or = 1500 g or gestational ages (GA) < or = 28 weeks. To determine the appropriate upper limits for ROP screening in Taiwan in terms of birth weight and gestational age, we performed a retrospective review of all 617 infants who were born at the National Taiwan University Hospital from January 1, 1994 to December 31, 1999, and survived beyond 28 days of life and received eye-ground evaluation under our current ROP screening guidelines. From the start of our study, the criteria for screening was birth weight <2000 g or gestational age < 35 weeks. The maximal stage of retinopathy observed was recorded. We found no ROP greater than stage I in infants with birth weights > 1500g and GA > 31 weeks. In comparing with our current guidelines, lowering the screening criteria to birth weight < or = 1500g or gestational age < or = 31 weeks reduced the number of infants requiring screening by 37.2%, while no case of ROP greater than stage 1 was missed. However, five cases of stage 2 ROP would have been missed in our study if the gestational age cut-off was < or = 28 weeks as recommended by AAP. Therefore, we recommend that in the tertiary nursery in Taiwan, the gestational age < or = 31 weeks or birth body weight < or = 1500 g should be screened for ROP regardless of clinical condition. The screening for larger infants with high risk of ROP requires further discretion of the attending physicians.
早产儿视网膜病变（ROP）是早产儿最重要的发病情况之一。美国儿科学会（AAP）最新的ROP筛查指南规定，出生体重≤1500克或胎龄（GA）≤28周的婴儿必须进行筛查。为了确定台湾地区ROP筛查在出生体重和胎龄方面的合适上限，我们对1994年1月1日至1999年12月31日在台湾大学附属医院出生、存活超过28天且按照我们当前的ROP筛查指南接受眼底评估的617例婴儿进行了回顾性研究。从我们的研究开始，筛查标准为出生体重<2000克或胎龄<35周。记录观察到的视网膜病变的最大阶段。我们发现，出生体重>1500克且GA>31周的婴儿中没有ROP超过I期的情况。与我们当前的指南相比，将筛查标准降低到出生体重≤1500克或胎龄≤31周，需要筛查的婴儿数量减少了37.2%，同时没有漏诊任何一例超过1期的ROP病例。然而，如果按照AAP的建议将胎龄临界值设为≤28周，则在我们的研究中会漏诊5例2期ROP病例。因此，我们建议在台湾的三级新生儿重症监护室，无论临床情况如何，胎龄≤31周或出生体重≤1500克的婴儿都应进行ROP筛查。对于有较高ROP风险的较大婴儿，筛查需要主治医生进一步斟酌。
