Department of Biostatistics, School of Public Health and Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.
Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
BMC Ophthalmol. 2024 Aug 23;24(1):364. doi: 10.1186/s12886-024-03637-w.
Retinopathy of prematurity (ROP), is a preventable leading cause of blindness in infants and is a condition in which the immature retina experiences abnormal blood vessel growth. The development of ROP is multifactorial; nevertheless, the risk factors are controversial. This study aimed to identify risk factors of time to development of ROP in Iran.
This historical cohort study utilized data from the hospital records of all newborns referred to the ROP department of Farabi Hospital (from 2017 to 2021) and the NICU records of infants referred from Mahdieh Hospital to Farabi Hospital. Preterm infants with birth weight (BW) ≤ 2000 g or gestational age (GA) < 34 wk, as well as selected infants with an unstable clinical course, as determined by their pediatricians or neonatologists, with BW > 2000 g or GA ≥ 34 wk. The outcome variable was the time to development of ROP (in weeks). Random survival forest was used to analyze the data.
A total of 338 cases, including 676 eyes, were evaluated. The mean GA and BW of the study group were 31.59 ± 2.39 weeks and 1656.72 ± 453.80 g, respectively. According to the criteria of minimal depth and variable importance, the most significant predictors of the time to development of ROP were duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of Total Parenteral Nutrition (TPN), mother age, birth order, number of surfactant administration, and on time screening. The concordance index for predicting survival of the fitted model was 0.878.
Our findings indicated that the duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of TPN, mother age, birth order, number of surfactant administrations, and on time screening are potential risk factors of prognosis of ROP. The associations between identified risk factors were mostly nonlinear. Therefore, it is recommended to consider the nature of these relationships in managing treatment and designing early interventions.
早产儿视网膜病变（ROP）是一种可预防的导致婴儿失明的主要原因，是一种不成熟的视网膜经历异常血管生长的情况。ROP 的发展是多因素的；然而，风险因素仍存在争议。本研究旨在确定伊朗 ROP 发展时间的危险因素。
这是一项回顾性队列研究，利用了 Farabi 医院 ROP 科（2017 年至 2021 年）所有新生儿的医院记录和 Mahdieh 医院转诊至 Farabi 医院的新生儿重症监护病房（NICU）记录中的数据。研究对象包括出生体重（BW）≤2000g 或胎龄（GA）<34 周的早产儿，以及儿科医生或新生儿科医生认为临床病情不稳定的选定早产儿，BW>2000g 或 GA≥34 周。结局变量为 ROP 发展时间（周）。随机生存森林用于分析数据。
共评估了 338 例病例，包括 676 只眼。研究组的平均 GA 和 BW 分别为 31.59±2.39 周和 1656.72±453.80g。根据最小深度和变量重要性标准，ROP 发展时间的最重要预测因子是通气持续时间、GA、吸氧持续时间、胆红素水平、抗生素使用时间、全肠外营养（TPN）持续时间、母亲年龄、出生顺序、表面活性剂使用次数和及时筛查。拟合模型的预测生存的一致性指数为 0.878。
我们的研究结果表明，通气持续时间、GA、吸氧持续时间、胆红素水平、抗生素使用时间、TPN 持续时间、母亲年龄、出生顺序、表面活性剂使用次数和及时筛查是 ROP 预后的潜在危险因素。确定的危险因素之间的关联大多是非线性的。因此，建议在管理治疗和设计早期干预措施时考虑这些关系的性质。
