Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina.
Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi.
Am J Perinatol. 2024 Nov;41(15):2152-2164. doi: 10.1055/a-2297-8644. Epub 2024 Apr 2.
This study aimed to identify the clinical and growth parameters associated with retinopathy of prematurity (ROP) in infants with necrotizing enterocolitis (NEC) and spontaneous ileal perforation (SIP).
We conducted a retrospective cohort study that compared clinical data before and after NEC/SIP onset in neonates, categorizing by any ROP and severe ROP (type 1/2) status.
The analysis included 109 infants with surgical NEC/SIP. Sixty infants (60/109, 55%) were diagnosed with any ROP, 32/109 (29.3%) infants (22% type 1 and 7.3% type 2) with severe ROP. On univariate analysis, those with severe ROP (32/109, 39.5%) were of lower median gestational age (GA, 23.8 weeks [23.4, 24.6] vs. 27.3 [26.3, 29.0], < 0.001), lower median birth weight (625 g [512, 710] vs. 935 [700, 1,180], < 0.001) and experienced higher exposure to clinical chorioamnionitis (22.6 vs. 2.13%, < 0.006), and later median onset of ROP diagnosis (63.0 days [47.0, 77.2] vs. 29.0 [19.0, 41.0], < 0.001), received Penrose drain placement more commonly (19 [59.4%] vs. 16 [34.0%], = 0.04), retained less residual small bowel (70.0 cm [63.1, 90.8] vs. 90.8 [72.0, 101], = 0.007) following surgery, were exposed to higher FiO 7 days after birth ( = 0.001), received ventilation longer and exposed to higher FiO at 2 weeks ( < 0.05) following NEC and developed acute kidney injury (AKI) more often (25 [86.2%] vs. 20 [46.5%], = 0.002) than those without ROP. Those with severe ROP had lower length, weight for length, and head circumference z scores. In an adjusted Firth's logistic regression, GA (adjusted odds ratio [aOR] = 0.51, 95% confidence interval [CI]: [0.35, 0.76]) and diagnosis at later age (aOR = 1.08, 95% CI: [1.03, 1.13]) was shown to be significantly associated with any ROP.
Infants who develop severe ROP following surgical NEC/SIP are likely to be younger, smaller, have been exposed to more O, develop AKI, and grow poorly compared with those did not develop severe ROP.
· Thirty percent of infants with NEC/SIP had severe ROP.. · Those with severe ROP had poor growth parameters before and after NEC/SIP.. · Risk factors based ROP prevention strategies are needed to have improved ophthalmic outcomes..
本研究旨在确定与坏死性小肠结肠炎（NEC）和自发性回肠穿孔（SIP）相关的早产儿视网膜病变（ROP）的临床和生长参数。
我们进行了一项回顾性队列研究，比较了 NEC/SIP 发病前后新生儿的临床数据，并根据有无 ROP 和严重 ROP（1/2 型）的情况进行分类。
分析纳入了 109 例接受手术治疗的 NEC/SIP 新生儿。60 例（60/109，55%）被诊断为存在任何 ROP，32 例（32/109，29.3%）婴儿（22%为 1 型，7.3%为 2 型）患有严重 ROP。单因素分析显示，患有严重 ROP（32/109，39.5%）的婴儿胎龄（GA）中位数较低（23.8 周 [23.4，24.6] vs. 27.3 [26.3，29.0]， < 0.001），出生体重中位数较低（625 g [512，710] vs. 935 [700，1180]， < 0.001），且更常经历临床绒毛膜羊膜炎（22.6% vs. 2.13%， < 0.006），ROP 诊断中位时间较晚（63.0 天 [47.0，77.2] vs. 29.0 [19.0，41.0]， < 0.001），更常接受彭罗斯引流管放置（19 [59.4%] vs. 16 [34.0%]， = 0.04），术后保留的残余小肠更少（70.0 cm [63.1，90.8] vs. 90.8 [72.0，101]， = 0.007），出生后 7 天 FiO2 更高（ = 0.001），NEC 后通气时间更长，FiO2 更高（ < 0.05），且更常发生急性肾损伤（AKI）（25 [86.2%] vs. 20 [46.5%]， = 0.002）。患有严重 ROP 的婴儿的身长、体重/身长和头围 Z 评分较低。在调整后的菲尔兹逻辑回归中，GA（调整后的优势比[aOR] = 0.51，95%置信区间[CI]：[0.35，0.76]）和较晚的诊断（aOR = 1.08，95% CI：[1.03，1.13]）与任何 ROP 显著相关。
与未发生严重 ROP 的婴儿相比，NEC/SIP 术后发生严重 ROP 的婴儿更可能胎龄更小、体重更轻、暴露于更多的氧气、发生 AKI 和生长不良。
· 30%的 NEC/SIP 婴儿患有严重 ROP。· 患有严重 ROP 的婴儿在 NEC/SIP 之前和之后的生长参数较差。· 需要基于风险因素的 ROP 预防策略，以改善眼部结局。
