Manzoni Paolo, Memo Luigi, Mostert Michael, Gallo Elena, Guardione Roberta, Maestri Andrea, Saia Onofrio Sergio, Opramolla Anna, Calabrese Sara, Tavella Elena, Luparia Martina, Farina Daniele
Neonatology and NICU, S. Anna Hospital, Torino Italy.
Neonatology, Ca' Foncello Hospital Treviso Italy.
Early Hum Dev. 2014 Sep;90 Suppl 2:S29-33. doi: 10.1016/S0378-3782(14)50009-6.
Retinopathy of prematurity (ROP) is a multifactorial disease with evidence of many associated risk factors. Erythropoietin has been reported to be associated with this disorder in a murine model, as well as in humans in some single-center reports. We reviewed the data from two large tertiary NICUs in Italy to test the hypothesis that the use of erythropoietin may be associated with the development of the most severe stages of ROP in extremely low birth weight (ELBW) neonates.
DESIGN/METHODS: Retrospective study by review of patient charts and eye examination index cards on infants with birth weight <1000g admitted to two large tertiary NICUs in Northern Italy (Sant'Anna Hospital NICU in Torino, and Ca' Foncello Hospital Neonatology in Treviso) in the years 2005 to 2007. Standard protocol of administration of EPO in the two NICUs consisted of 250 UI/kg three times a week for 6-week courses (4-week in 1001-1500g infants). Univariate analysis was performed to assess whether the use of EPO was associated with severe (threshold) ROP. A control, multivariate statistical analysis was performed by entering into a logistic regression model a number of neonatal and perinatal variables that - in univariate analysis - had been associated with threshold ROP.
During the study period, 211 ELBW infants were born at the two facilities and survived till discharge. Complete data were obtained for 197 of them. Threshold retinopathy of prematurity occurred in 26.9% (29 of 108) of ELBW infants who received erythropoietin therapy, as compared with 13.5% (12 of 89) of those who did not receive erythropoietin (OR 2.35; 95% CI 1.121-4.949; p=0.02 in univariate analysis, and p=0.04 at multivariate logistic regression after controlling for the following variables: birth weight, gestational age, days on supplemental oxygen, systemic fungal infection, vaginal delivery). Use of erythropoietin was not significantly associated with other major sequelae of prematurity (intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis). © 2014 Elsevier Ireland Ltd. All rights reserved.
Use of erythropoietin is an additional, independent predictor of threshold ROP in ELBW neonates. Larger prospective, population-based studies should further clarify the extent of this association.
早产儿视网膜病变（ROP）是一种多因素疾病，有许多相关危险因素的证据。据报道，在小鼠模型以及一些单中心报告的人类研究中，促红细胞生成素与这种疾病有关。我们回顾了意大利两家大型三级新生儿重症监护病房（NICU）的数据，以检验促红细胞生成素的使用可能与极低出生体重（ELBW）新生儿ROP最严重阶段的发生有关这一假设。
设计/方法：通过回顾2005年至2007年期间入住意大利北部两家大型三级NICU（都灵的圣安娜医院NICU和特雷维索的卡方切洛医院新生儿科）的出生体重<1000g婴儿的病历和眼科检查索引卡进行回顾性研究。两家NICU促红细胞生成素（EPO）的标准给药方案为每周三次，每次250 UI/kg，疗程6周（1001 - 1500g婴儿为4周）。进行单因素分析以评估EPO的使用是否与严重（阈值）ROP相关。通过将单因素分析中与阈值ROP相关的一些新生儿和围产期变量纳入逻辑回归模型进行对照多变量统计分析。
在研究期间，两家机构共出生211例ELBW婴儿并存活至出院。其中197例获得了完整数据。接受促红细胞生成素治疗的ELBW婴儿中，26.9%（108例中的29例）发生了阈值早产儿视网膜病变，而未接受促红细胞生成素治疗的婴儿中这一比例为13.5%（89例中的12例）（单因素分析中OR为2.35；95%CI为1.121 - 4.949；p = 0.02，在控制以下变量后进行多变量逻辑回归时p = 0.04：出生体重、胎龄、吸氧天数、全身性真菌感染、阴道分娩）。促红细胞生成素的使用与早产儿的其他主要后遗症（脑室内出血、支气管肺发育不良、坏死性小肠结肠炎）无显著关联。© 2014爱思唯尔爱尔兰有限公司。保留所有权利。
促红细胞生成素的使用是ELBW新生儿阈值ROP的一个额外独立预测因素。更大规模的前瞻性、基于人群的研究应进一步阐明这种关联的程度。
