Population, Practice and Policy Research and Teaching Department, UCL GOS Institute of Child Health, London, United Kingdom.
Ophthalmology Department, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom.
PLoS One. 2023 Aug 18;18(8):e0287658. doi: 10.1371/journal.pone.0287658. eCollection 2023.
Early detection is critical to achieving optimal outcomes in children with congenital cataract. We hypothesized that detection of congenital cataract in preterm infants would be delayed compared with term/post-term peers due to delayed delivery of whole population child health interventions.
Secondary analysis of data using a nested case-control study approach in a prospective population-based cohort study. Inclusion criteria comprised children diagnosed with congenital cataract requiring surgical intervention during the first two years of life in UK and Ireland in 2009 and 2010. Association between late detection (after eight weeks post-natal age, ie outside the neonatal and infant eye national screening programme) of cataract and preterm birth (gestational age less than 37 weeks) was assessed using multivariable logistic regression.
Of 186 children with congenital cataract, 17 children were born preterm (9%, gestational age range 24-37weeks). Neonatal detection occurred in 64/186 (34%), and late detection in 64 children (34%). Late detection was independently associated with premature birth, specifically moderate/late preterm birth (adjusted odds ratio 3.0, 95%CI 1.1 to 8.5).
Our findings suggest that, despite enhanced eye surveillance being recommended for those born moderate/late preterm (32+ weeks gestational age, ie not eligible for retinopathy of prematurity screening), congenital cataract is not being effectively detected through the routine screening programme for this vulnerable group. It is necessary to improve the effectiveness of the screening programme, and care must be taken to ensure that competing health care needs of preterm children do not prevent universal child health interventions.
对于先天性白内障患儿，早期发现对获得最佳治疗效果至关重要。我们假设，由于全人群儿童健康干预措施的延迟实施，早产儿先天性白内障的发现时间会晚于足月儿/过期产儿。
对一项前瞻性基于人群的队列研究中嵌套病例对照研究的数据进行二次分析。纳入标准为 2009 年至 2010 年在英国和爱尔兰出生、在两岁以内被诊断为需要手术干预的先天性白内障患儿。采用多变量逻辑回归评估白内障晚期（出生后 8 周后，即不在新生儿和婴儿眼部国家筛查计划内）发现与早产（胎龄<37 周）之间的关系。
在 186 例先天性白内障患儿中，有 17 例（9%，胎龄范围为 24-37 周）为早产儿。186 例患儿中，64 例（34%）新生儿期发现，64 例（34%）为晚期发现。晚期发现与早产，特别是中晚期早产（校正比值比 3.0，95%CI 1.1 至 8.5）独立相关。
我们的研究结果表明，尽管推荐对中晚期早产儿（32 周以上胎龄，即不符合早产儿视网膜病变筛查标准）加强眼部监测，但通过该脆弱人群的常规筛查计划，未能有效发现先天性白内障。有必要提高筛查计划的有效性，并且必须注意避免早产儿的其他保健需求妨碍普遍的儿童保健干预措施。
