由于提高了氧饱和度目标，早产儿视网膜病变的风险增加：一项多中心研究。

Increased risk of retinopathy of prematurity since increased O saturation targets: A multi-centre study.

机构信息

Department of Ophthalmology, Queensland Children's Hospital, Brisbane, Queensland, Australia.

Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.

出版信息

J Paediatr Child Health. 2023 Sep;59(9):1067-1074. doi: 10.1111/jpc.16456. Epub 2023 Jun 20.

DOI:10.1111/jpc.16456

PMID:37338156

Abstract

BACKGROUND/AIMS: Retinopathy of prematurity (ROP) is a leading cause of visual impairment in premature neonates. The BOOST II, SUPPORT and COT trials recommended increasing O saturation targets for pre-term neonates to reduce mortality; however, this is a risk factor for ROP. We aimed to determine whether these targets increased prevalence of ROP among pre-term neonates and higher risk groups.

METHODS

Retrospective cohort study conducted using data from the Australian and New Zealand Neonatal Network. 17 298 neonate cohort born 2012-2018 at <32 weeks' GA and/or <1500 g BW was analysed. Adjusted odds ratios (aORs) were calculated for post-2015 risk of: any ROP; ROP ≥ Stage 2; and treated ROP. Sub-analysis stratified at <28 GA, < 26 weeks' GA, <1500 g BW and <1000 g BW was performed.

RESULTS

Risk of any ROP increased in the post-2015 group (aOR = 1.23, 95% confidence interval (CI) = 1.14-1.32), <28 weeks' GA (aOR = 1.31, 95% CI = 1.17-1.46), <26 weeks (aOR = 1.57, 95% CI = 1.28-1.91), <1500 g (aOR = 1.24, 95% CI = 1.14-1.34) and <1000 g (aOR = 1.34, 95% CI = 1.20-1.50). ROP ≥ Stage 2 increased at <28 weeks (aOR = 1.30, 95% CI = 1.16-1.46), <26 weeks (aOR = 1.57, 95% CI = 1.28-1.91), <1500 g (aOR = 1.18, 95% CI = 1.08-1.30), and <1000 g (aOR = 1.26, 95% CI = 1.13-1.42).

CONCLUSION

O therapy guidelines since 2015 have resulted in decreased mortality but increased risk of ROP. Individualised NICU adjustments of ROP screening/follow-up methods are necessary to address the clinical burden.

摘要

背景/目的：早产儿视网膜病变（ROP）是早产儿致盲的主要原因。BOOST II、SUPPORT 和 COT 试验建议提高早产儿的氧饱和度目标，以降低死亡率；然而，这也是 ROP 的一个危险因素。我们旨在确定这些目标是否会增加早产儿和高危儿的 ROP 患病率。

方法

这是一项使用澳大利亚和新西兰新生儿网络数据进行的回顾性队列研究。分析了 2012 年至 2018 年胎龄<32 周和/或体重<1500 克的 17298 例新生儿队列。计算了 2015 年后的以下风险的校正比值比（aOR）：任何 ROP；ROP≥2 期；和治疗 ROP。在<28 周 GA、<26 周 GA、<1500 克 BW 和<1000 克 BW 进行了分层亚分析。

结果

2015 年后组的任何 ROP 风险增加（aOR=1.23，95%置信区间[CI]1.14-1.32），<28 周 GA（aOR=1.31，95%CI1.17-1.46），<26 周（aOR=1.57，95%CI1.28-1.91），<1500 克（aOR=1.24，95%CI1.14-1.34）和<1000 克（aOR=1.34，95%CI1.20-1.50）。ROP≥2 期在<28 周 GA（aOR=1.30，95%CI1.16-1.46），<26 周 GA（aOR=1.57，95%CI1.28-1.91），<1500 克 BW（aOR=1.18，95%CI1.08-1.30）和<1000 克 BW（aOR=1.26，95%CI1.13-1.42）增加。