Mao J B, Yu X T, Shen L J, Wu M Y, Lyu Z, Lao J M, Li H X, Wu H F, Chen Y Q
The Affiliated Eye Hospital of Whenzhou Medical University at HangZhou, HangZhou 310020, China.
The Affiliated Obstetrics and Gynecology Hospital of Medical College of Zhejiang University, HangZhou 310006, China.
Zhonghua Yan Ke Za Zhi. 2019 Apr 11;55(4):280-288. doi: 10.3760/cma.j.issn.0412-4081.2019.04.010.
To observe the incidence and severity of retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) infants by strictly controlling the risk factors of ROP, such as oxygen inhalation after birth, to explore the related factors of ROP in ELBW infants. This was a cross-sectional study. 166 ELBW infants underwent neonatal screening were enrolled in this study, whose birth weight was less than 1 000 g. There were 79 males and 87 females infants, whose average gestational age was (27.99±1.73)weeks, and average birth weight was (904.45±80.23)g. According to the final screening results, the ELBW infants were grouped as follows: (1)ROP group and non-ROP group; (2)severe ROP group and mild or no ROP group. Risk factors included gestational age, birth weight, test-tube infants, fetuses number, complications during pregnancy, delivery mode and Apgar scores in 1 to 10 minutes, weight and weight gain proportion at 1-6 weeks after birth, postnatal feeding mode, history of oxygen inhalation, anemia and blood transfusion, and other systemic diseases were recorded. And their correlation with severe ROP was analyzed by SPSS 20.0 statistical software. Ninty-four (56.63%) ELBW infants developed ROP, 16 (9.64%) were severe ROP and 14(8.43%) received treatment. Average birth weight between ROP group (911.95±72.80)g and non-ROP group (894.67±88.58)g had no difference(1.379, 0.170). Average gestational age between ROP group (27.49±1.53) weeks and non-ROP group (28.64±1.76) weeks had significant difference(-4.491,0.001).And pregnancy-induced hypertension during pregnancy (χ(2)=4.479, 0.034), Apgar score in 5 minutes (-2.760, 0.006) and 10 minutes (-2.099, 0.043), pneumonia (χ(2)=6.233, 0.013), neonatal pneumonia (χ(2)=18.026, 0.001) had significant difference between ROP group and non-ROP group. There was no effect on weight (0.009,0.753) or weight gain proportion (2.394,0.124) at 1-6 weeks after birth in ELBW infants with or without ROP. Average birth weight between severe ROP group(875.63±74.85)g and mild or no ROP group(907.53±80.41)g had no difference(-1.518, 0.131).Average gestational age between severe ROP group(26.88±1.31)weeks and mild or no ROP group (28.11±1.73)weeks had significant difference(-2.766,0.006).And only fundus hemorrhage (χ(2)=4.507,0.034) had significant difference between severe ROP group and mild or no ROP group. There was no effect on weight (2.683,0.103) or weight gain proportion (0.431,0.513) at 1-6 weeks after birth in ELBW infants with or without ROP. Logistic regression analysis revealed that only gestational age was correlated to the incidence (β=-0.437,0.001) and severity (β=-0.616,0.007) of ROP significantly. By strictly controlling the risk factors of ROP, such as oxygen inhalation after birth, the severe rate of ROP in ELBW infants is low. However, gestational age is still the inevitable independent high risk factor for the incidence of ROP in ELBW infants. .
通过严格控制早产儿视网膜病变（ROP）的危险因素，如出生后吸氧，观察极低出生体重（ELBW）婴儿ROP的发生率和严重程度，探讨ELBW婴儿ROP的相关因素。这是一项横断面研究。本研究纳入166例接受新生儿筛查的ELBW婴儿，其出生体重小于1000g。其中男婴79例，女婴87例，平均胎龄为（27.99±1.73）周，平均出生体重为（904.45±80.23）g。根据最终筛查结果，将ELBW婴儿分为以下几组：（1）ROP组和非ROP组；（2）重度ROP组和轻度或无ROP组。记录危险因素，包括胎龄、出生体重、试管婴儿、胎儿数量、孕期并发症、分娩方式及1至10分钟的阿氏评分、出生后1至6周的体重及体重增加比例、产后喂养方式、吸氧史、贫血及输血情况以及其他全身性疾病。并采用SPSS 20.0统计软件分析其与重度ROP的相关性。94例（56.63%）ELBW婴儿发生ROP，16例（9.64%）为重度ROP，14例（8.43%）接受了治疗。ROP组平均出生体重（911.95±72.80）g与非ROP组（894.67±88.58）g之间无差异（1.379，0.170）。ROP组平均胎龄（27.49±1.53）周与非ROP组（28.64±1.76）周之间有显著差异（-4.491，0.001）。孕期妊娠高血压（χ²=4.479，0.034）、5分钟（-2.760，0.006）和10分钟（-2.099，0.043）阿氏评分、肺炎（χ²=6.233，0.013）、新生儿肺炎（χ²=18.026，0.001）在ROP组和非ROP组之间有显著差异。出生后1至6周，有无ROP的ELBW婴儿体重（0.009，0.753）或体重增加比例（2.394，0.124）均无影响。重度ROP组平均出生体重（875.63±74.85）g与轻度或无ROP组（907.53±80.41）g之间无差异（-1.518，0.131）。重度ROP组平均胎龄（26.88±1.31）周与轻度或无ROP组（28.11±1.73）周之间有显著差异（-2.766，0.006）。且重度ROP组与轻度或无ROP组之间仅眼底出血（χ²=4.507，0.034）有显著差异。出生后1至6周，有无ROP的ELBW婴儿体重（2.683，0.103）或体重增加比例（0.431，0.513）均无影响。Logistic回归分析显示，仅胎龄与ROP的发生率（β=-0.437，0.001）和严重程度（β=-0.616，0.007）显著相关。通过严格控制ROP危险因素，如出生后吸氧，ELBW婴儿ROP的重度发生率较低。然而，胎龄仍然是ELBW婴儿ROP发生不可避免的独立高危因素。
