Departments of Pediatrics and.
Research, University of Kansas School of Medicine at Wichita, Wichita, KS.
Neoreviews. 2020 Apr;21(4):e249-e263. doi: 10.1542/neo.21-4-e249.
The incidence of retinopathy of prematurity (ROP) is showing an increasing trend in the United States. This may be because of increasing survival rates among extremely preterm infants (<25 weeks' gestation) and targeting higher oxygen saturation. Five randomized clinical trials of low versus high oxygen saturation target ranges found increased mortality in the low oxygen saturation target group and an increased incidence of ROP in the high oxygen saturation target group. The American Academy of Pediatrics recommends using an oxygen saturation target range of 90% to 95% in extremely low-birthweight infants. The change of practice to target this higher oxygen saturation range, from admission until discharge, may be contributing to the increasing incidence of ROP in extremely preterm infants. To decrease the incidence of ROP without increasing mortality, 2 new cohort trials suggest gradually increasing oxygen saturation targets as preterm infants mature. There is evidence that human milk, vitamin A, and omega-3 fatty acids can help, in addition to continuous oxygen saturation monitoring, to decrease the risk of ROP. We review this literature and provide a meta-analysis to evaluate the evidence.
早产儿视网膜病变（ROP）的发病率在美国呈上升趋势。这可能是由于极早产儿（<25 周妊娠）的存活率增加和目标更高的氧饱和度。五项比较低氧饱和度目标范围与高氧饱和度目标范围的随机临床试验发现，低氧饱和度目标组的死亡率增加，高氧饱和度目标组的 ROP 发病率增加。美国儿科学会建议极低出生体重儿使用 90%至 95%的氧饱和度目标范围。从入院到出院，将实践目标调整到更高的氧饱和度范围，可能是导致极早产儿 ROP 发病率增加的原因。为了在不增加死亡率的情况下降低 ROP 的发病率，2 项新的队列试验表明，随着早产儿的成熟，逐渐增加氧饱和度目标。有证据表明，除了持续的氧饱和度监测外，人乳、维生素 A 和欧米伽-3 脂肪酸也有助于降低 ROP 的风险。我们回顾了这方面的文献，并进行了荟萃分析来评估证据。
