Colaizy Tarah T, Longmuir Susannah, Gertsch Kevin, Abràmoff Michael David, Klein Jonathan M
Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States.
Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States.
Invest Ophthalmol Vis Sci. 2017 Feb 1;58(2):887-891. doi: 10.1167/iovs.16-20822.
To compare progression of retinopathy of prematurity (ROP) before and after institution of an oxygen therapy protocol to inhibit active proliferation and progression of ROP in premature infants.
A retrospective cohort study was performed of premature infants undergoing ROP screening before (cohort A) and after (cohort B) implementation of an oxygen therapy protocol to inhibit further progression for those with stage 2 ROP or worse. Statistical analysis with χ2, Fisher's exact test, or Wilcoxon rank sum test was performed; and logistic regression models were created to determine the odds ratio of cohort B developing ROP progression beyond stage 2, compared to cohort A, adjusting for other risk factors for ROP.
In cohort A, without oxygen therapy protocol (2002-2007), 44% (54/122) of infants progressed beyond stage 2, compared to 23% (24/103) of infants after protocol implementation (cohort B, 2008-2012) (P = 0.001). No significant differences between cohort A and B were found for gestational age, birth weight, survival, sepsis, bronchopulmonary dysplasia, oxygen at discharge, or need for diuretics. Infants with stage 2 ROP in cohort B, with oxygen therapy protocol, had significantly decreased risk of ROP beyond stage 2 (odds ratio 0.37, 95% confidence interval 0.20-0.67; P = 0.0013), compared to cohort A, correcting for differences in birth weight and necrotizing enterocolitis.
Progression from stage 2 to stage 3 ROP in premature infants was significantly decreased after implementation of an oxygen therapy protocol, without a corresponding increase in pulmonary morbidity. This study suggests that appropriate oxygen therapy may play a role in inhibiting progression of stage 2 ROP, potentially decreasing the risk of lifelong visual loss in this vulnerable population.
比较在采用氧气治疗方案抑制早产儿视网膜病变（ROP）的活跃增殖和进展之前和之后ROP的进展情况。
对在氧气治疗方案实施之前（队列A）和之后（队列B）接受ROP筛查的早产儿进行了一项回顾性队列研究，该方案用于抑制患有2期或更严重ROP的患儿的病情进一步发展。采用χ2检验、Fisher精确检验或Wilcoxon秩和检验进行统计分析；并建立逻辑回归模型，以确定与队列A相比，队列B发生ROP进展超过2期的比值比，并对其他ROP危险因素进行校正。
在没有氧气治疗方案的队列A（2002 - 2007年）中，44%（54/122）的婴儿病情进展超过2期，而在方案实施后（队列B，2008 - 2012年）这一比例为23%（24/103）（P = 0.001）。在胎龄、出生体重、生存率、败血症、支气管肺发育不良（BPD）、出院时吸氧情况或使用利尿剂的需求方面，队列A和队列B之间未发现显著差异。与队列A相比，在氧气治疗方案下，队列B中患有2期ROP的婴儿病情进展超过2期的风险显著降低（比值比0.37，95%置信区间0.20 - 0.67；P = 0.0013），校正了出生体重和坏死性小肠结肠炎的差异。
实施氧气治疗方案后，早产儿从2期ROP进展到3期的情况显著减少，且肺部发病率没有相应增加。本研究表明，适当的氧气治疗可能在抑制2期ROP进展中发挥作用，有可能降低这一脆弱人群终身视力丧失的风险。
