Siswanto Johanes Edy, Dijk Peter H, Bos Arend F, Sitorus Rita S, Adisasmita Asri C, Ronoatmodjo Sudarto, Sauer Pieter J J
Neonatology Working Group, Department of Pediatrics Harapan Kita Women and Children Hospital Jakarta Indonesia.
Faculty of Medicine Pelita Harapan University Tangerang Indonesia.
Health Sci Rep. 2021 Jan 18;4(1):e219. doi: 10.1002/hsr2.219. eCollection 2021 Mar.
Retinopathy of prematurity (ROP) is a severe disease in preterm infants. It is seen more frequently in Low-Middle Income Countries (LMIC) like Indonesia compared to High-Income Countries (HIC). Risk factors for ROP development are -extreme- preterm birth, use of oxygen, neonatal infections, respiratory problems, inadequate nutrition, and blood and exchange transfusions. In this paper, we give an overview of steps that can be taken in LMIC to prevent ROP and provide guidelines for screening and treating ROP.
Based on the literature search and data obtained by us in Indonesia's studies, we propose guidelines for the prevention, screening, and treatment of ROP in preterm infants in LMIC.
Prevention of ROP starts before birth with preventing preterm labor, transferring a mother who might deliver <32 weeks to a perinatal center and giving corticosteroids to mothers that might deliver <34 weeks. Newborn resuscitation must be done using room air or, in the case of very preterm infants (<29-32 weeks) by using 30% oxygen. Respiratory problems must be prevented by starting continuous positive airway pressure (CPAP) in all preterm infants <32 weeks and in case of respiratory problems in more mature infants. If needed, the surfactant should be given in a minimally invasive manner, as ROP's lower incidence was found using this technique. The use of oxygen must be strictly regulated with a saturation monitor of 91-95%. Infections must be prevented as much as possible. Both oral and parenteral nutrition should be started in all preterm infants on day one of life with preferably mothers' milk. Blood transfusions can be prevented by reducing the amount of blood needed for laboratory analysis.
Preterm babies should be born in facilities able to care for them optimally. The use of oxygen must be strictly regulated. ROP screening is mandatory in infants born <34 weeks, and infants who received supplemental oxygen for a prolonged period. In case of progression of ROP, immediate mandatory treatment is required.
Concerted action is needed to reduce the incidence of ROP in LMIC. "STOP - R1O2P3" is an acronym that can help implement standard practices in all neonatal intensive care units in LMIC to prevent development and progression.
早产儿视网膜病变（ROP）是早产儿的一种严重疾病。与高收入国家（HIC）相比，在印度尼西亚等中低收入国家（LMIC）更为常见。ROP发生的危险因素包括极早产、吸氧、新生儿感染、呼吸问题、营养不足以及输血和换血。在本文中，我们概述了中低收入国家可采取的预防ROP的措施，并提供ROP筛查和治疗指南。
基于文献检索以及我们在印度尼西亚研究中获得的数据，我们提出了中低收入国家早产儿ROP预防、筛查和治疗的指南。
ROP的预防在出生前就开始，包括预防早产、将可能在32周前分娩的母亲转运至围产期中心，并给可能在34周前分娩的母亲使用皮质类固醇。新生儿复苏必须使用空气进行，对于极早产儿（<29 - 32周），则使用30%的氧气。对于所有32周以下的早产儿以及更成熟婴儿出现呼吸问题时，必须通过启动持续气道正压通气（CPAP）来预防呼吸问题。如有需要，应以微创方式给予表面活性剂，因为使用该技术发现ROP的发病率较低。必须使用饱和度监测仪将氧饱和度严格控制在91% - 95%来严格规范吸氧。必须尽可能预防感染。所有早产儿在出生第一天就应开始经口和肠外营养，最好使用母乳。通过减少实验室分析所需的血量可以避免输血。
早产儿应在能够对其进行最佳护理的机构出生。必须严格规范吸氧。对于孕周<34周出生的婴儿以及长期接受补充氧气的婴儿，ROP筛查是强制性的。如果ROP病情进展，则需要立即进行强制性治疗。
需要采取一致行动以降低中低收入国家ROP的发病率。“STOP - R1O2P3”是一个首字母缩写词，有助于在中低收入国家的所有新生儿重症监护病房实施标准做法，以预防其发生和进展。
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