Indiana University School of Medicine, Indianapolis, IN, USA.
Department of Ophthalmology, Indiana University School of Medicine, Indianapolis, IN, USA.
BMC Ophthalmol. 2024 May 24;24(1):220. doi: 10.1186/s12886-024-03483-w.
Retinopathy of prematurity (ROP) is a disease that affects preterm infants born younger than 30 weeks of gestation. The pathophysiology of ROP involves an initial vaso-obliterative phase followed by vaso-proliferative phase that leads to disease progression. The use of supplemental oxygen during the vaso-proliferative phase of ROP has been associated with reduced disease progression, but how this impacts the need for ROP treatment is unclear. The goal of this study was to compare the rate of laser or intravitreal bevacizumab after implementation of a new supplemental oxygen therapy protocol in preterm infants with stage 2 ROP.
This is a retrospective chart review of preterm infants diagnosed with stage 2 ROP at Riley Hospital for Children between 1/2017 and 12/2022. Patients diagnosed between 1/2017 and 6/2020 were classified as Cohort A, preprotocol implementation. Patients diagnosed from 8/2020 to 12/2022 were classified as Cohort B, postprotocol implementation. In Cohort A, oxygen saturation was kept at 91-95% through the entire hospitalization. In Cohort B, oxygen saturation was increased to 97-99% as soon as Stage 2 ROP was diagnosed. Statistical analyses were performed using chi-square and Student's T test, followed by multivariate analyses to determine the impact of the oxygen protocol on the need for ROP treatment.
A total of 211 patients were diagnosed with stage 2 ROP between 1/2017 and 12/2022. Of those patients, 122 were before protocol implementation therapy (Cohort A), and 89 were after implementation of supplemental oxygen protocol (Cohort B). Gestational age was slightly higher in Cohort B (Cohort A 25.3 ± 1.9, Cohort B 25.8 ± 1.84, p = 0.04). There was no difference in birth weight, NEC, BPD, or survival. Cohort B had lesser need for invasive mechanical ventilation and higher days on CPAP during hospitalization. Notably, Cohort A had 67 (55%) patients treated with laser photocoagulation or intravitreal bevacizumab versus 20 (22%) patients in Cohort B (OR 0.19, 0.08-0.40).
The need for laser photocoagulation or intravitreal bevacizumab was significantly decreased in high-risk patients treated with the supplemental oxygen protocol. This result supports the idea that targeted supplemental oxygen therapy to keep saturations between 97 and 99% can reduce disease progression in infants with stage 2 ROP and potentially decrease the burden of additional procedures.
早产儿视网膜病变（ROP）是一种影响胎龄小于 30 周的早产儿的疾病。ROP 的病理生理学涉及初始血管闭塞阶段，随后是血管增生阶段，导致疾病进展。ROP 的血管增生阶段使用补充氧气与疾病进展减少有关，但这如何影响 ROP 治疗的需求尚不清楚。本研究的目的是比较在实施新的补充氧疗方案后，患有 2 期 ROP 的早产儿接受激光或玻璃体内贝伐单抗治疗的比率。
这是对 2017 年 1 月至 2022 年 12 月期间在 Riley 儿童医院诊断为 2 期 ROP 的早产儿进行的回顾性图表审查。2017 年 1 月至 6 月期间诊断的患者被归类为 A 队列，在方案实施前。2020 年 8 月至 12 月期间诊断的患者被归类为 B 队列，在方案实施后。在 A 队列中，整个住院期间血氧饱和度保持在 91-95%。在 B 队列中，一旦诊断出 2 期 ROP，就将血氧饱和度提高到 97-99%。使用卡方检验和学生 t 检验进行统计分析，然后进行多变量分析，以确定氧气方案对 ROP 治疗需求的影响。
2017 年 1 月至 12 月期间，共有 211 名患者被诊断为 2 期 ROP。其中，122 名患者在方案实施前接受治疗（A 队列），89 名患者在实施补充氧疗方案后接受治疗（B 队列）。B 队列的胎龄略高（A 队列 25.3±1.9，B 队列 25.8±1.84，p=0.04）。出生体重、NEC、BPD 或存活率无差异。B 队列在住院期间需要较少的有创机械通气和更高的 CPAP 天数。值得注意的是，A 队列中有 67（55%）名患者接受了激光光凝或玻璃体内贝伐单抗治疗，而 B 队列中只有 20（22%）名患者（OR 0.19，0.08-0.40）。
在接受补充氧疗方案治疗的高危患者中，激光光凝或玻璃体内贝伐单抗的需求显著降低。这一结果支持这样一种观点，即目标性补充氧疗将饱和度维持在 97%至 99%之间，可以减少 2 期 ROP 婴儿的疾病进展，并可能减少额外治疗程序的负担。
