Department of Pediatrics, University of Kansas Medical School-Wichita, and Pediatrix Medical Group, Wesley Medical Center, Wichita, KS 67214, USA.
Neonatology. 2011;100(2):116-29. doi: 10.1159/000322848. Epub 2011 Mar 2.
For more than 50 years it has been known that oxygen therapy can lead to retinopathy of prematurity (ROP). Recent clinical research has led many neonatologists to lower the target oxygen saturation alarm limits to 85-93% and to titrate the inspired oxygen in small increments. Despite efforts to optimize oxygen therapy, the number of cases of severe ROP remains high as more extremely low birth weight infants survive. Based on new insights into the pathogenesis of ROP, there are multiple interventions, in addition to optimizing oxygen therapy that may help decrease severe ROP. Interventions that have the potential to prevent phase I ROP (birth to ≤32 weeks PMA) include increasing retinal erythropoietin (exogenous rHuEPO) and serum IGF-1 (breast milk and/or exogenous IGF-1), maintaining serum glucose below 120 mg, and providing omega-3 supplements. Interventions with potential to prevent proliferative ROP in phase II (infants >32-34 weeks PMA) include treating anemia with a liberal policy of transfusion in premature infants with stage III ROP, photopic adaptation, vitamin E supplements (>34 weeks PMA), and omega-3 supplements. The WINROP algorithm has shown promise as a biomarker in the early identification of extremely low birth weight infants at high risk for proliferative ROP. As there is interplay of multiple factors in the causation of ROP, we suggest that the simultaneous application of some combination of multiple interventions, mentioned above, may reduce the burden of ROP in the most vulnerable infants. These concepts need study in well-designed randomized clinical trials before being incorporated into clinical practice.
五十多年来，人们已经知道氧疗可能导致早产儿视网膜病变（ROP）。最近的临床研究促使许多新生儿科医生将目标氧饱和度报警下限降至 85-93%，并逐渐增加吸入氧气的浓度。尽管努力优化氧疗，但由于更多极低出生体重儿存活，严重 ROP 的病例数量仍然很高。基于对 ROP 发病机制的新认识，除了优化氧疗外，还有多种干预措施可能有助于减少严重 ROP。除了优化氧疗外，还有多种干预措施可能有助于减少严重 ROP。除了优化氧疗外，还有多种干预措施可能有助于减少严重 ROP。有潜力预防 I 期 ROP（出生至≤32 周 PMA）的干预措施包括增加视网膜促红细胞生成素（外源性 rHuEPO）和血清 IGF-1（母乳和/或外源性 IGF-1）、将血清葡萄糖维持在 120mg 以下，并提供欧米茄-3 补充剂。有潜力预防 II 期（32-34 周 PMA 以上婴儿）增殖性 ROP 的干预措施包括用输血治疗 III 期 ROP 早产儿的贫血，光适应，维生素 E 补充剂（>34 周 PMA）和欧米茄-3 补充剂。WINROP 算法已显示出作为一种生物标志物的潜力，可早期识别极高危增殖性 ROP 的极低出生体重儿。由于 ROP 的病因涉及多种因素的相互作用，我们建议同时应用上述多种干预措施的某种组合，可能会降低最脆弱婴儿 ROP 的负担。在将这些概念纳入临床实践之前，需要在精心设计的随机临床试验中进行研究。
