Yildirim Mustafa, Coban Asuman, Bulut Ozgul, Mercül Nur Kir, Ince Zeynep
Department of Pediatrics, Division of Neonatology, Istanbul University Faculty of Medicine, Istanbul, Turkey.
Department of Ophthalmology, Istanbul University Faculty of Medicine, Istanbul, Turkey.
J Matern Fetal Neonatal Med. 2024 Dec;37(1):2337720. doi: 10.1080/14767058.2024.2337720. Epub 2024 Apr 14.
Infants who meet the screening guidelines for retinopathy of prematurity (ROP) based on birth weight and gestational age undergo serial ophthalmological examinations for its detection and treatment. However, <10% of patients require treatment, and less than half develop ROP. Poor postnatal weight gain has been reported to be a strong indicator of ROP development; however, the information regarding this is unclear. Therefore, this study aimed to determine the relationship between postnatal weight gain and ROP development in preterm infants.
The data of 675 preterm infants with gestational age ≤32 weeks, who were hospitalized in our neonatal intensive care unit, were obtained retrospectively from file records. The infants' demographic characteristics, clinical findings, and weekly weight gain (g/kg/day) during the first 8 weeks were recorded. The univariate was used to examine the risk factors for ROP followed by multivariate regression.
The incidence of ROP in the infants included in the study was 41% ( = 278) and 13.3% ( = 37) of them required treatment. In the infants of the group that developed ROP, the mean birth weight and gestational age were significantly lower than those in the group that did not develop ROP (973 ± 288 and 1301 ± 349 g, = 0.001 and 28.48 ± 1.95 and 30.08 ± 1.60 weeks, = 0.001, respectively). As the gestational week and birth weight decreased, ROP development and the risk of ROP-requiring treatment increased. In the infants of the group that developed ROP, the mean weight gain in the postnatal third week was detected as significantly lower compared to those in the group that did not develop ROP (13.9 ± 8.2 and 15.4 ± 6.8 g, = 0.034). On multiple logistic regression analysis, birth weight (<750 g) (odds ratio [OR], 8.67; 95% confidence interval [CI], 3.99-18.82, = 0.001), blood transfusion (OR, 2.39; 95% CI, 1.34-4.24, = 0.003), necrotizing enterocolitis (OR, 4.79; 95% CI, 1.05-26.85, = 0.045), bronchopulmonary dysplasia (OR, 2.03; 95% CI, 1.22-3.36, = 0.006), antenatal steroid therapy (OR, 1.60; 95% CI, 1.05-2.43, = 0.028), surfactant administration (OR, 2.06; 95% CI, 1.32-3.2, = 0.001) were independent risk factors for ROP development.
Postnatal weight gain may not be an accurate predictor of ROP development after adjusting for confounding factors. However, the analysis of independent risk factors that influenced the development of ROP revealed a statistically significant effect in cases of low birth weight, blood transfusion, necrotizing enterocolitis, bronchopulmonary dysplasia, and antenatal steroid and surfactant therapies. These findings may help ophthalmologists and neonatologists to pay special attention to this patient group during ROP scanning.
根据出生体重和胎龄符合早产儿视网膜病变（ROP）筛查指南的婴儿需接受系列眼科检查以进行检测和治疗。然而，不到10%的患者需要治疗，且不到一半的患者会发生ROP。据报道，出生后体重增加不佳是ROP发生的一个有力指标；然而，关于这方面的信息尚不清楚。因此，本研究旨在确定早产儿出生后体重增加与ROP发生之间的关系。
回顾性收集我院新生儿重症监护病房住院的675例胎龄≤32周的早产儿资料。记录婴儿的人口统计学特征、临床表现以及出生后前8周的每周体重增加量（g/kg/天）。采用单因素分析ROP的危险因素，随后进行多因素回归分析。
纳入研究的婴儿中ROP发生率为41%（n = 278），其中13.3%（n = 37）需要治疗。发生ROP的婴儿组的平均出生体重和胎龄显著低于未发生ROP的婴儿组（分别为973±288和1301±349 g，P = 0.001；28.48±1.95和30.08±1.60周，P = 0.001）。随着孕周和出生体重降低，ROP发生及需要治疗的风险增加。发生ROP的婴儿组出生后第三周的平均体重增加量显著低于未发生ROP的婴儿组（分别为13.9±8.2和15.4±6.8 g，P = 0.034）。多因素logistic回归分析显示，出生体重（<750 g）（比值比[OR]，8.67；95%置信区间[CI]，3.99 - 18.82，P = 0.001）、输血（OR，2.39；95% CI]，1.34 - 4.24，P = 0.003）、坏死性小肠结肠炎（OR，4.79；95% CI，1.05 - 26.85，P = 0.045）、支气管肺发育不良（OR，2.03；95% CI，1.22 - 3.36，P = 0.006）、产前类固醇治疗（OR，1.60；95% CI，1.05 - 2.43，P = 0.028）、表面活性剂应用（OR，2.06；95% CI，1.32 - 3.2，P = 0.001）是ROP发生的独立危险因素。
校正混杂因素后，出生后体重增加可能不是ROP发生的准确预测指标。然而，对影响ROP发生的独立危险因素分析显示，低出生体重、输血、坏死性小肠结肠炎、支气管肺发育不良以及产前类固醇和表面活性剂治疗情况下具有统计学显著效应。这些发现可能有助于眼科医生和新生儿科医生在ROP筛查期间对该患者群体给予特别关注。
