Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Division of Neonatology, Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Paediatr Int Child Health. 2020 May;40(2):85-91. doi: 10.1080/20469047.2019.1631588. Epub 2019 Jul 5.
: Poor postnatal weight gain has been associated with low serum IGF-1, a key factor in the pathogenesis of retinopathy of prematurity (ROP).: To investigate an association between relative weight gain (RWG) and severe ROP in very low-birthweight (VLBW) Thai infants.: The medical records of VLBW infants who were admitted to the neonatal intensive care unit in Chiang Mai University Hospital from June 2014 to December 2016 and screened for ROP were reviewed. RWG and total calorie intake (TCI) in the 2nd, 4rth and 6th week of age were calculated and those with no ROP/mild ROP and severe ROP requiring laser treatment were compared.: The study included 139 VLBW infants, 24 (17.3%) of whom had ROP requiring laser treatment. Infants with severe ROP requiring laser treatment had a lower median birthweight (840 1,195 g, < 0.001) and median gestational age (GA) (27 30 wk, < 0.001) than those with no ROP/mild ROP. When RWG and TCI were compared, the infants with severe ROP requiring laser treatment had a lower RWG at the 2nd ( < 0.01) and 4th weeks of age ( < 0.05) and had a lower TCI at the 2nd week of age ( < 0.001) than those with no ROP/mild ROP. Multivariate logistic analysis demonstrated that GA <29.5 w ( < 0.01), hypotension ( < 0.05), RWG <2.9 g/kg/d ( < 0.05) and TCI <98.5 kcal/kg/day ( < 0.001) at the 2nd week of age were independent risk factors for severe ROP requiring laser treatment.: Poor weight gain and low calorie intake at the 2nd week of age were associated with severe ROP requiring laser treatment in VLBW infants. Monitoring weight gain and calorie intake during this period are essential and may improve the outcome of ROP.: BPD, bronchopulmonary dysplasia; IVH, intraventricular haemorrhage; NEC, necrotising enterocolitis; PDA, patent ductus arteriosus; PRC, packed red cells; PVL, periventricular leucomalacia; RDS, respiratory distress syndrome; ROP, retinopathy of prematurity; RWG, relative weight gain; SGA, small for gestational age; TCI, total calorie intake; VLBW, very low birthweight.
体重增加不足与血清 IGF-1 水平降低有关，而 IGF-1 是早产儿视网膜病变（ROP）发病机制中的关键因素。本研究旨在探讨极低出生体重儿（VLBW）的相对体重增加（RWG）与严重 ROP 之间的关系。
对 2014 年 6 月至 2016 年 12 月在清迈大学医院新生儿重症监护病房住院并接受 ROP 筛查的 VLBW 婴儿的病历进行了回顾性分析。计算了婴儿在第 2、4 和 6 周时的 RWG 和总热量摄入（TCI），并比较了无 ROP/轻度 ROP 和需要激光治疗的严重 ROP 婴儿。
本研究纳入了 139 例 VLBW 婴儿，其中 24 例（17.3%）需要激光治疗 ROP。需要激光治疗严重 ROP 的婴儿的出生体重（840 1,195g， <0.001）和胎龄（GA）（27 30 周， <0.001）中位数明显低于无 ROP/轻度 ROP 婴儿。当比较 RWG 和 TCI 时，需要激光治疗严重 ROP 的婴儿在第 2 周（ <0.01）和第 4 周（ <0.05）时的 RWG 较低，第 2 周时的 TCI 较低（ <0.001）。多变量逻辑分析表明，GA <29.5 周（ <0.01）、低血压（ <0.05）、第 2 周时 RWG <2.9g/kg/d（ <0.05）和 TCI <98.5kcal/kg/天（ <0.001）是需要激光治疗严重 ROP 的独立危险因素。
在 VLBW 婴儿中，第 2 周时体重增加不良和热量摄入不足与需要激光治疗的严重 ROP 相关。在此期间监测体重增加和热量摄入非常重要，可能会改善 ROP 的结局。
BPD，支气管肺发育不良；IVH，脑室内出血；NEC，坏死性小肠结肠炎；PDA，动脉导管未闭；PRC，浓缩红细胞；PVL，脑室周围白质软化；RDS，呼吸窘迫综合征；ROP，早产儿视网膜病变；RWG，相对体重增加；SGA，小于胎龄儿；TCI，总热量摄入；VLBW，极低出生体重。
