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阿根廷国家早产儿视网膜病变所致儿童失明预防计划(2004 - 2016年)的成果

Results of the National Program for the Prevention of Blindness in Childhood by Retinopathy of Prematurity in Argentina (2004-2016).

作者信息

Alda Ernesto, Lomuto Celia C, Benítez Alicia M, Bouzas Liliana, Brussa Marina, Cattaino Adriana, Dinerstein N Alejandro, Erpen Norma, Galina Lidia, Mansilla Celeste, Marinaro Silvia, Quiroga Ana, Saidman Gabriela, Sánchez Celia, Sepúlveda Teresa, Visintin Patricia

机构信息

Dirección de Maternidad, Infancia y Adolescencia (DINAMIA), Ministerio de Salud de la Nación, Ciudad de Buenos Aires, Argentina.

出版信息

Arch Argent Pediatr. 2018 Dec 1;116(6):386-393. doi: 10.5546/aap.2018.eng.386.

Abstract

INTRODUCTION

The ROP Argentina Group was created in 2003 and is responsible for the National Program for the Prevention of Blindness in Childhood by Retinopathy of Prematurity (ROP) in Argentina.

OBJETIVES

To describe the program implementation and results achieved in relation to ROP care in terms of effectiveness, access, and quality (2004-2016).

POPULATION AND METHODS

Descriptive, retrospective study with a dynamic cohort carried out in facilities that are part of the registry. Eligible population: All preterm newborn infants with risk factors for ROP.

RESULTS

Participating health care services increased from 14 to 98 and covered the 23 provinces and the Autonomous City of Buenos Aires. A total of 956 infants were born with < 1500 g in 2004 and 2739, in 2016. Of these, 22.7 % had some degree of ROP and 7.8 % required treatment (severe ROP). Vision screening exceeded 90 %, and treatments at the place of origin increased (57 %-92 %). The incidence of unusual cases is still high (17.3 % of treated cases), and missed opportunities are still recorded. The use of anti-angiogenic drugs trebled since 2011, when they started to be used.

CONCLUSIONS

Significant achievements were observed in terms of program representativeness, scope, and adherence, and also in relation to screening access and treatment at the place of origin; however, the incidence of ROP is still high. The persistence of unusual cases and missed opportunities evidences deficiencies in the quality of health care and outpatient followup and underlines the need to strengthen the program actions in relation to services.

摘要

引言

阿根廷早产儿视网膜病变(ROP)小组于2003年成立,负责阿根廷全国早产儿视网膜病变致儿童失明预防计划。

目标

描述该计划在有效性、可及性和质量方面(2004 - 2016年)关于ROP护理的实施情况及取得的成果。

人群与方法

在登记册所属机构中对动态队列进行描述性回顾性研究。符合条件的人群:所有有ROP危险因素的早产新生儿。

结果

参与的医疗服务机构从14家增加到98家,覆盖了23个省和布宜诺斯艾利斯自治市。2004年共有956名出生体重<1500克的婴儿,2016年为2739名。其中,22.7%有某种程度的ROP,7.8%需要治疗(重度ROP)。视力筛查率超过90%,在原地接受治疗的比例有所增加(从57%增至92%)。异常病例的发生率仍然很高(占治疗病例的17.3%),仍有漏诊情况记录。自2011年开始使用抗血管生成药物以来,其使用量增加了两倍。

结论

在计划的代表性、范围和依从性方面,以及在筛查可及性和原地治疗方面都取得了显著成就;然而,ROP的发生率仍然很高。异常病例和漏诊情况的持续存在证明了医疗保健和门诊随访质量存在缺陷,并强调需要加强该计划在服务方面的行动。

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