Lin Wen-Hsien, Chen Shu-Jen, Lee Fenq-Lin
Department of Pediatrics, Chutung Veterans Hospital, Chutung, Taiwan.
Acta Paediatr Taiwan. 2003 Mar-Apr;44(2):84-8.
Timely detection of the threshold retinopathy of prematurity (ROP) is very important. The goal of this study was to discuss the optimal timing of the initial screening for ROP as well as ROP progression in the outpatient department (OPD) follow-up after discharge. Herein we retrospectively review the charts of 224 preterm babies with gestational ages (GAs) of less than 35 weeks or birth weights (BWs) of less than or equal to 2000 g. These babies were admitted to Taipei Veterans General Hospital from January 1998 to December 2000. The relationship between the severity and the time course of ROP with respect to various BWs was recorded. These infants were also divided into groups according to the ROP stage of the last retinal examination before discharge, and the recorded results of OPD follow-up. In this study, there was a total of 41 infants with stage III ROP, of which 36 progressed to threshold ROP, including 13 (13/41, 31.7%) and 10 (10/36, 27.8%) who were respectively detected after discharge. In 89 infants with positive findings, the postnatal age (PNA) at the time ROP was detected for the first time was about 7 weeks in extremely low birth weight (ELBW, BW < or = 1000 g) infants and about 4-5 weeks in larger infants; however the postconceptional age (PCA) was about 35 to 36 weeks, and this was not influenced by birth weight. The earliest PCA and PNA when infants with a BW of < or = 1,000 g or GA < or = 28 weeks reached the threshold ROP were 33 and 7 weeks; infants with a BW of 1,001-1,250 g or GA of 28-30 weeks, the times were 34 and 6 weeks; and for infants with a BW of > 1,250 g or GA of more than 30 weeks, they were 35 and 4 weeks, respectively. Although it seemed that ROP tended to develop at the same PCA, the dual criteria of 4 weeks of PNA or 33 weeks of PCA, whichever comes later, may be the optimal timing for the initial retinal examination for premature infants. It is also important to keep in mind that follow-up programs should not be interrupted because of discharge.
及时发现阈值早产儿视网膜病变（ROP）非常重要。本研究的目的是探讨ROP初始筛查的最佳时机以及出院后门诊随访中ROP的进展情况。在此，我们回顾性分析了224例孕周（GA）小于35周或出生体重（BW）小于或等于2000g的早产儿病历。这些婴儿于1998年1月至2000年12月入住台北荣民总医院。记录了不同BW下ROP严重程度与病程之间的关系。这些婴儿还根据出院前最后一次视网膜检查的ROP阶段以及门诊随访记录结果进行分组。本研究中，共有41例III期ROP婴儿，其中36例进展为阈值ROP，包括出院后分别被发现的13例（13/41，31.7%）和10例（10/36，27.8%）。在89例有阳性发现的婴儿中，极低出生体重（ELBW，BW≤1000g）婴儿首次发现ROP时的出生后年龄（PNA）约为7周，较大婴儿约为4 - 5周；然而，孕龄（PCA）约为35至36周，且不受出生体重影响。BW≤1000g或GA≤28周的婴儿达到阈值ROP时最早的PCA和PNA分别为33周和7周；BW为1001 - 1250g或GA为28 - 30周的婴儿，时间分别为34周和6周；对于BW＞1250g或GA超过30周的婴儿，分别为35周和4周。尽管ROP似乎倾向于在相同的PCA时发展，但PNA 4周或PCA 33周（以较晚者为准）的双重标准可能是早产儿初次视网膜检查的最佳时机。同样重要的是要记住，随访计划不应因出院而中断。
