Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
Section for Ophthalmology, Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Br J Ophthalmol. 2020 Jul;104(7):943-949. doi: 10.1136/bjophthalmol-2019-314874. Epub 2019 Nov 1.
BACKGROUND/AIMS: During the last decade, improved neonatal care has resulted in increased survival of the most immature infants and improved health of more mature infants. We hypothesise that this has affected incidence and treatment of retinopathy of prematurity (ROP), enabling guidelines for screening to be modified.
In Sweden, all infants with gestational age (GA) at birth ≤30 weeks are screened for ROP. Results are registered in a web-based register, Swedish National ROP Register, with a coverage rate of 97%. Incidence of ROP and frequency of treatment, aspects on natural course of ROP and number of examinations, are calculated in relation to GA at birth in infants born during 2008-2017.
Of 7249 infants, 31.9% (2310) had ROP and 6.1% (440) were treated. No infant with GA 30 weeks was treated. Incidence of ROP remained similar, but frequency of treatment increased (p=0.023). Over time, GA and birth weight were reduced in infants with ROP and with treated ROP. In the most immature infants, postmenstrual age was lower and postnatal age was higher when any ROP and stage 3 ROP were first detected (p<0.001). At treatment, postmenstrual but not postnatal age of the infant was associated with GA (p<0.001). During the 10-year period, 46 038 examinations were performed.
Modification of Swedish guidelines is proposed, including only infants with a GA of <30 weeks and postponing the first examination with 1 week in infants with GA 26-29 weeks. This would spare many infants from stressful examinations and reduce eye examinations with at least 20%.
背景/目的：在过去的十年中，新生儿护理水平的提高使得最不成熟的婴儿存活率提高，更成熟的婴儿健康状况得到改善。我们假设这影响了早产儿视网膜病变（ROP）的发病率和治疗，从而使筛查指南得以修改。
在瑞典，所有出生时胎龄（GA）≤30 周的婴儿都接受 ROP 筛查。结果在一个基于网络的登记处，即瑞典国家 ROP 登记处进行登记，覆盖率为 97%。根据 2008 年至 2017 年出生的婴儿的出生 GA，计算 ROP 的发生率和治疗频率、ROP 的自然病程以及检查次数等方面。
在 7249 名婴儿中，31.9%（2310 名）患有 ROP，6.1%（440 名）接受了治疗。没有 GA 为 30 周的婴儿接受治疗。ROP 的发病率保持不变，但治疗频率增加（p=0.023）。随着时间的推移，ROP 婴儿和接受 ROP 治疗的婴儿的 GA 和出生体重降低。在最不成熟的婴儿中，当首次发现任何 ROP 和 3 期 ROP 时，胎儿龄较低，而出生后年龄较高（p<0.001）。在治疗时，婴儿的胎龄而不是出生后年龄与 GA 相关（p<0.001）。在 10 年期间，共进行了 46038 次检查。
建议修改瑞典指南，仅包括 GA<30 周的婴儿，并将 GA 为 26-29 周的婴儿的首次检查推迟 1 周。这将使许多婴儿免受有压力的检查，并减少至少 20%的眼部检查。
