Department of Ophthalmology, University of California, Sacramento, California, USA.
children's hospital of philadelphia, philadelphia, PA, USA.
Ophthalmic Epidemiol. 2023 Jun;30(3):317-325. doi: 10.1080/09286586.2022.2111687. Epub 2022 Sep 12.
Excessive oxygen supplementation increases risk of retinopathy of prematurity (ROP). While numerous oxygen parameters could be considered when predicting ROP (saturation targets, actual saturation, fraction of inspired oxygen, etc.), complicated measures are impractical as screening criteria. We sought to develop a simple, clinically useful measure of daily oxygen supplementation during ages 0-28 days to improve prediction of ROP.
econdary analysis of two Postnatal Growth and ROP (G-ROP) Study cohorts (G-ROP-1 and G-ROP-2) at 45 hospitals. Infants with a known ROP outcome and complete oxygen data were included. Associations between severe ROP and days on supplemental oxygen (FiO2 > 21%), during ages 0-28 days (DSO28) were assessed, controlling for birth weight (BW) and gestational age (GA). New screening criteria incorporating DSO were developed and compared to current guidelines.
Among 8,949 studied infants, 459 (5.1%) developed type 1 ROP. DSO28 was associated with severe ROP (adjusted-OR 1.05 per day supplemental oxygen, 95%CI 1.03-1.07, p < .0001). The following criteria had 100% sensitivity for type 1 ROP and higher specificity than current guidelines: new BW/GA criteria with DSO (BW<901 g, GA<26 weeks, or DSO >3), 23.4% fewer infants examined; modified G-ROP criteria including DSO, 29.0% fewer infants; original G-ROP criteria, 31.8% fewer infants.
In high-level neonatal-care settings, incorporating DSO (a simple measure of oxygen supplementation) into screening criteria improves sensitivity and specificity for type 1 ROP over current BW-GA criteria, but does not perform as well as the validated G-ROP criteria.
过度氧疗会增加早产儿视网膜病变（ROP）的风险。在预测 ROP 时，可以考虑许多氧参数（如饱和度目标、实际饱和度、吸入氧分数等），但复杂的措施作为筛查标准并不实际。我们试图开发一种简单的、临床有用的方法，用于测量 0-28 天龄内的每日氧疗补充量，以提高对 ROP 的预测能力。
对 45 家医院的两个新生儿生长和 ROP（G-ROP）研究队列（G-ROP-1 和 G-ROP-2）进行二次分析。纳入了已知 ROP 结局且具有完整氧疗数据的婴儿。评估了在 0-28 天龄（DSO28）期间，严重 ROP 与补充氧天数（FiO2>21%）之间的关系，并控制了出生体重（BW）和胎龄（GA）。制定了纳入 DSO 的新筛查标准，并与现行指南进行了比较。
在 8949 名研究婴儿中，459 名（5.1%）发生 1 型 ROP。DSO28 与严重 ROP 相关（校正后每天补充氧气的比值比为 1.05，95%CI 为 1.03-1.07，p<0.0001）。以下标准对 1 型 ROP 具有 100%的敏感性，且比现行指南具有更高的特异性：新的 BW/GA 标准加 DSO（BW<901g，GA<26 周，或 DSO>3），减少了 23.4%的婴儿接受检查；包括 DSO 的改良 G-ROP 标准，减少了 29.0%的婴儿；原始 G-ROP 标准，减少了 31.8%的婴儿。
在高水平新生儿护理环境中，将 DSO（一种简单的氧疗补充量测量方法）纳入筛查标准可提高 1 型 ROP 的敏感性和特异性，优于现行的 BW-GA 标准，但不如经过验证的 G-ROP 标准有效。
