印度尼西亚早产儿视网膜病变的多中心调查。
Multicentre survey of retinopathy of prematurity in Indonesia.
机构信息
Neonatology, Universitair Medisch Centrum Groningen, Groningen, The Netherlands.
Neonatology, Harapan Kita National Centre for Women and Children's Health, Jakarta, Indonesia.
出版信息
BMJ Paediatr Open. 2021 Jan 22;5(1):e000761. doi: 10.1136/bmjpo-2020-000761. eCollection 2021.
BACKGROUND
The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants.
OBJECTIVE
To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia.
SETTING
Data were collected from 34 hospitals with different levels of care: national referral centres, university-based hospitals, and public and private hospitals.
METHODS
A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016-2017 in relation to gestational age and birth weight.
RESULTS
We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28-32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%-5%. Both mortality and the incidence of ROP were highest in university-based hospitals.
CONCLUSIONS
In the 2016-2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016-2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia.
背景
印度尼西亚早产儿视网膜病变（ROP）的发病率高于高收入国家。为了降低该疾病的发病率，2010 年印度尼西亚发布了关于ROP 的预防、筛查和治疗的方案。为了协助方案的实际实施，在印度尼西亚所有地区举行了会议，提请注意ROP 的高发病率以及降低发病率的方法。此外，2014 年引入了国家健康保险，使更多婴儿能够获得 ROP 的筛查和治疗。
目的
评估关注ROP 高发病率的指南和国家健康保险的引入是否可能影响印度尼西亚ROP 的发病率。
设置
数据来自不同级别护理的 34 家医院收集：国家转诊中心、大学附属医院、公立和私立医院。
方法
对 2016-2017 年与胎龄和出生体重相关的入院人数、死亡率、ROP 发病率及其分期进行了问卷调查。
结果
我们确定了 12115 名胎龄小于 34 周的合格婴儿。死亡率为 24%，任何分期 ROP 为 6.7%。胎龄小于 28 周的婴儿死亡率为 67%，所有分期 ROP 为 18%，重度 ROP 为 4%。在 28-32 周龄组，死亡率为 24%，所有分期 ROP 为 7%，重度 ROP 为 4%-5%。大学附属医院的死亡率和 ROP 发病率均最高。
结论
在 2016-2017 年期间，印度尼西亚 32 周龄前婴儿的死亡率高于高收入国家，但 ROP 的发病率相当。由于高死亡率，这一发病率可能被低估。2016-2017 年 ROP 的发病率低于 2015 年前进行的调查。这种下降可能是由于印度尼西亚对 ROP 的认识提高和国家健康保险的实施。
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