Neonatal Intensive Care Unit, Women and Children's Program, Providence St Vincent Medical Center, Portland, OR 97225, USA.
J Perinatol. 2011 Apr;31(4):251-7. doi: 10.1038/jp.2010.152. Epub 2011 Jan 13.
Strategies to reduce Retinopathy of Prematurity (ROP) have focused primarily on respiratory management. Hyperglycemia (HG) and insulin use, risk factors for adult diabetic retinopathy, as well as growth rates may be modifiable variables useful to reduce ROP.
This was a retrospective chart review of all infants born at <30 weeks gestation from 2003 to 2007 who survived to discharge in our neonatal intensive care unit (NICU). All whole-blood glucose values (BG in mg dl(-1)) done in the first 29 days of life were collected for analysis.
BGs were done at least every 3 to 6 h for the first 48 to 96 h of life, then every 6 to 24 h thereafter, as long as infants remained on hyperalimentation. Hyperglycemia was defined as mild (BG 151 to 180), moderate (181 to 210) or severe (>210). Insulin use (given if BG>180 to 210) was also noted for each simultaneous BG. ROP was classified as none, mild (stage 1 to 2) or severe (stage 3 to 4). Growth velocity (g kg(-1) per day), length and head circumference were also analyzed. In all, 372 infants mean (s.d.) gestational age 27.6 (1.4) weeks, mean (s.d.) birth weight 994 (242)g had 18,649 BGs analyzed. 103 (28%) of the infants had mild ROP and 29 (8%) had severe ROP. 137 (37%) of the infants received at least 1 day of exogenous insulin (median days 9, range 1 to 26). Higher cumulative mean BG, more episodes of HG, and more insulin exposure were associated with an increased incidence and severity of ROP. Ordinal logistic regression identified lower gestational age, male gender, fetal growth restriction, slower NICU growth velocity, and higher BG as predictors for severity of ROP. However, insulin use was a stronger predictor than BG, and replaced it in the risk model.
After adjusting for important risk factors, HG and especially insulin use in premature infants may increase the risk of ROP. In addition, slower NICU growth velocity, but not rates of head or length growth, was predictive of ROP.
降低早产儿视网膜病变（ROP）的策略主要集中在呼吸管理上。高血糖症（HG）和胰岛素的使用是成人糖尿病性视网膜病变的危险因素，而生长速度可能是有助于降低 ROP 的可调节变量。
这是对我们新生儿重症监护病房（NICU）中 2003 年至 2007 年间出生胎龄<30 周且存活至出院的所有婴儿进行的回顾性图表审查。收集了出生后前 29 天内进行的所有全血血糖值（以 mg dl(-1)表示）进行分析。
在生命的前 48 至 96 小时内，婴儿接受高营养支持时，血糖值至少每 3 至 6 小时检测一次，此后每 6 至 24 小时检测一次。高血糖症定义为轻度（BG 151 至 180）、中度（181 至 210）或重度（>210）。同时也记录了每个同时 BG 时的胰岛素使用情况（如果 BG>180 至 210，则给予胰岛素）。ROP 分为无、轻度（1 至 2 期）或重度（3 至 4 期）。还分析了生长速度（g kg(-1)每天）、长度和头围。共有 372 名婴儿，平均（标准差）胎龄 27.6（1.4）周，平均（标准差）出生体重 994（242）g，共分析了 18649 次 BG。103 名（28%）婴儿患有轻度 ROP，29 名（8%）婴儿患有重度 ROP。137 名（37%）婴儿至少接受了 1 天的外源性胰岛素（中位数天数 9 天，范围 1 至 26 天）。更高的累积平均 BG、更高比例的 HG 发作和更多的胰岛素暴露与 ROP 的发生率和严重程度增加相关。有序逻辑回归确定了较低的胎龄、男性、胎儿生长受限、NICU 生长速度较慢以及较高的 BG 是 ROP 严重程度的预测因素。然而，胰岛素的使用是比 BG 更强的预测因素，并且取代了它在风险模型中。
在调整了重要的危险因素后，早产儿的 HG，尤其是胰岛素的使用可能会增加 ROP 的风险。此外，NICU 生长速度较慢，但不是头围或长度生长速度，是 ROP 的预测因素。
