78例孕龄22 - 25周婴儿的早产儿视网膜病变的风险及临床病程
Risk and clinical course of retinopathy of prematurity in 78 infants of gestational age 22-25 weeks.
作者信息
Miller Marijean M, Revenis Mary E, Lai Michael M, Meleth Annal D, Jeffress Elaine S, Carrera Ana, Cheng Yao I, Sill Ann M, McCarter Robert
机构信息
Department of Ophthalmology, Children's National Medical Center and The George Washington University, Washington, DC; Department of Pediatrics, Children's National Medical Center and The George Washington University, Washington, DC.
Department of Pediatrics, Children's National Medical Center and The George Washington University, Washington, DC.
出版信息
J AAPOS. 2014 Jun;18(3):266-70. doi: 10.1016/j.jaapos.2014.01.016.
PURPOSE
To characterize the retinopathy of prematurity (ROP) and survival of infants born at gestational age (GA) of 22-25 weeks.
METHODS
This study was a comparative case series for the total set of 78 infants ≤25 GA screened for ROP at a level IV NICU during a 21-month period. Data are presented on infants screened for ROP from 6 weeks after birth for 22 and 23 weeks' GA infants and from 5 weeks after birth for 24 and 25 weeks' GA. Accounting for the competing risk of mortality, we implemented Cox CR regression models to assess birth weight, GA, and admission diagnosis as potential risk factors for the following time to event outcomes: type 1 disease, aggressive posterior ROP (AP-ROP), plus disease, first presentation of ROP, and worst ROP observed.
RESULTS
Risk of laser treatment (subhazard ratio [SHR] = 0.56, P = 0.007) and of plus disease (SHR = 0.49, P = 0.001) was increased among those born at lower GA. Twenty infants required laser for type 1 disease at median postmenstrual age (PMA) of 35.8 weeks (range, 33.0-42.7); infants with AP-ROP had laser at PMA of 34.5 weeks (range, 33.0-36.9), 2 weeks earlier than infants without AP-ROP at PMA 36.5 weeks (range, 33.9-42.7). The cumulative probability of receiving laser therapy approached 46% (22 or 23 weeks' GA), 30% (24 weeks' GA), and 18% (25 weeks' GA).
CONCLUSIONS
The 2013 screening guidelines appear to be appropriate for infants of 22 and 23 weeks' GA when ROP screening begins at PMA 31 weeks.
目的
描述孕22 - 25周出生婴儿的早产儿视网膜病变（ROP）情况及生存状况。
方法
本研究是一项比较性病例系列研究，对在21个月期间于一家四级新生儿重症监护病房（NICU）接受ROP筛查的78例孕龄（GA）≤25周的婴儿进行了研究。对于孕22和23周的婴儿，从出生后6周开始筛查ROP数据；对于孕24和25周的婴儿，从出生后5周开始筛查。考虑到死亡的竞争风险，我们采用Cox CR回归模型来评估出生体重、孕龄和入院诊断作为以下事件发生时间结局的潜在风险因素：1型疾病、侵袭性后部ROP（AP - ROP）、附加病变、首次出现ROP以及观察到的最严重ROP。
结果
孕龄较低的婴儿接受激光治疗的风险（亚风险比[SHR]=0.56，P = 0.007）和附加病变的风险（SHR = 0.49，P = 0.001）增加。20例婴儿因1型疾病在月经后年龄（PMA）中位数为35.8周（范围33.0 - 42.7周）时需要激光治疗；患有AP - ROP的婴儿在PMA为34.5周（范围33.0 - 36.9周）时接受激光治疗，比未患AP - ROP的婴儿在PMA 36.5周（范围33.9 - 42.7周）时早2周。接受激光治疗的累积概率在孕22或23周时接近46%，孕24周时为30%，孕25周时为18%。
结论
当ROP筛查在PMA 31周开始时，2013年的筛查指南似乎适用于孕22和23周的婴儿。
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