Tao Katsuo
Department of Cardiology, Fukuoka Children's Hospital, 5-1-1, Kashiiteriha, Higasi-ku, Fukuoka city, Fukuoka, 813-0017, Japan.
Pediatr Neonatol. 2022 May;63(3):220-226. doi: 10.1016/j.pedneo.2021.09.005. Epub 2021 Nov 20.
Postnatal systemic steroids are known to increase the risk of developing retinopathy of prematurity (ROP). However, whether the total dosage and type of postnatal systemic steroids are related to the development and severity of ROP in premature infants remains unclear. This study was conducted to identify the risk factors for ROP and investigate the relationship between photocoagulation (PC)-demanding severe ROP and the postnatal dosage of any type of systemic steroids.
A total of 75 infants born at <28 weeks of postmenstrual age (PMA) were enrolled. The number of PC procedures for ROP was evaluated as the objective variable. This study analyzed the following independent variables: gestational age; birth weight; sex; Apgar scores; duration of mechanical ventilation; duration of nasal intermittent positive pressure ventilation; mean saturation and mean oxygen concentration administration until 36 weeks of PMA; total accumulation dosage of hydrocortisone, dexamethasone, and systemic steroids; dosage number of times of erythropoietin; total dosage of red cell concentrates (RCC); incidence of necrotizing enterocolitis (NEC) and focal intestinal perforation; sepsis; bronchopulmonary dysplasia (BPD); and intraventricular hemorrhage (IVH). Logistic regression was used to estimate the relative risk (odds ratio (OR)) associated with risk factors for PC-demanding severe ROP.
Compared with infants in the non-PC group, PC-treated infants had younger gestational age, longer mechanical ventilation periods, and higher dosage of systemic steroids and dexamethasone. Multivariate logistic regression analysis revealed total dosage of systemic steroids as the only risk factor for PC-demanding severe ROP. Based on receiver operating characteristic (ROC) curve analysis, a cutoff value of 8.95 mg/kg of postnatal systemic steroid administration was identified as a useful marker to predict PC-demanding severe ROP.
By focusing on the method of systemic steroid administration and avoiding excessive doses for infants born at <28 weeks of PMA, preventing the development of severe ROP is possible.
已知产后全身性使用类固醇会增加早产儿发生视网膜病变（ROP）的风险。然而，产后全身性类固醇的总剂量和类型是否与早产儿ROP的发生及严重程度相关仍不清楚。本研究旨在确定ROP的危险因素，并调查需要进行光凝治疗（PC）的重度ROP与产后任何类型全身性类固醇剂量之间的关系。
共纳入75例孕龄小于28周的婴儿。将ROP的PC治疗次数作为客观变量进行评估。本研究分析了以下自变量：胎龄；出生体重；性别；阿氏评分；机械通气时间；鼻间歇正压通气时间；孕龄36周前的平均血氧饱和度和平均吸氧浓度；氢化可的松、地塞米松和全身性类固醇的总累积剂量；促红细胞生成素的给药次数；红细胞浓缩液（RCC）的总剂量；坏死性小肠结肠炎（NEC）和局灶性肠穿孔的发生率；败血症；支气管肺发育不良（BPD）；以及脑室内出血（IVH）。采用逻辑回归分析来估计与需要进行PC治疗的重度ROP危险因素相关的相对风险（比值比（OR））。
与非PC治疗组的婴儿相比，接受PC治疗的婴儿胎龄更小、机械通气时间更长，全身性类固醇和地塞米松的剂量更高。多因素逻辑回归分析显示全身性类固醇的总剂量是需要进行PC治疗的重度ROP的唯一危险因素。基于受试者工作特征（ROC）曲线分析，确定产后全身性类固醇给药量8.95 mg/kg的截断值为预测需要进行PC治疗的重度ROP的有效指标。
通过关注全身性类固醇的给药方法，避免对孕龄小于28周的婴儿使用过量剂量，有可能预防重度ROP的发生。
