Keith C G, Doyle L W
Division of Paediatrics, Royal Women's Hospital, Carlton, Australia.
Pediatrics. 1995 Jan;95(1):42-5.
To review the survival rate, the incidence and severity of retinopathy of prematurity (ROP), and the rate of blindness caused by ROP in extremely low birth weight (ELBW, birth weight 500 to 999 g) infants born between January 1, 1977, and December 31, 1992, and to determine whether increasing survival rates of ELBW infants are accompanied by an increase in the rates of severe ROP or blindness.
Prospective cohort study of ELBW infants. Survival rates and visual outcomes were contrasted between children born in successive 8-year periods (1977 through 1984 and 1985 through 1992, inclusive).
The premature nurseries at the Royal Women's Hospital, Melbourne, a level-3 perinatal center.
Of 1001 inborn ELBW infants over the 16-year period, 457 (45.7%) survived their initial hospitalization: of the survivors, 434 (95.0%) were examined by the ophthalmologist, starting at 2 weeks of age if possible, then 2-weekly unit discharge. Children were reassessed after discharge at ages ranging from 1 to 10 years.
Survival rates to hospital discharge rose significantly over time, from 34.5% (145/420) in 1977 through 1984, to 53.7% (312/581) in 1985 through 1992 (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.7 to 2.8). Of the 434 surviving ELBW infants seen by the ophthalmologist, ROP was detected in 48.2% (68/141) in 1977 through 1984, which dropped significantly to 35.8% (105/293) in 1985 through 1992 (OR 0.6, 95% CI 0.4 to 0.9). Severe ROP (bilateral stages 3 to 5) was detected in 25.5% (36/141) in 1977 through 1984, and 17.7% (52/293) in 1985 through 1992, but the reduction was not quite statistically significant (OR 0.6, 95% CI 0.4 to 1.0). Bilateral blindness (visual acuity in each eye less than 6/60) caused by ROP occurred in only 4 (0.88%) survivors overall, 2 in each era.
The increase in the survival rate of ELBW infants is not always accompanied by an increase in the rate of severe ROP or blindness, at least for ELBW infants born in some large level-3 centers.
回顾1977年1月1日至1992年12月31日出生的极低出生体重（ELBW，出生体重500至999克）婴儿的存活率、早产儿视网膜病变（ROP）的发病率和严重程度以及ROP导致的失明率，并确定ELBW婴儿存活率的提高是否伴随着严重ROP或失明率的增加。
对ELBW婴儿进行前瞻性队列研究。对比连续8年期间（1977年至1984年以及1985年至1992年，含这两个时间段）出生的儿童的存活率和视力结果。
墨尔本皇家妇女医院的早产病房，一家三级围产期中心。
在这16年期间出生的1001例ELBW住院婴儿中，457例（45.7%）在首次住院后存活：在这些幸存者中，434例（95.0%）由眼科医生进行检查，若可能从2周龄开始检查，然后在出院时每2周检查一次。出院后在1至10岁期间对儿童进行重新评估。
到出院时的存活率随时间显著上升，从1977年至1984年的34.5%（145/420）升至1985年至1992年的53.7%（312/581）（优势比[OR]2.2，95%置信区间[CI]1.7至2.8）。在眼科医生检查的434例存活的ELBW婴儿中，1977年至1984年期间ROP的检出率为48.2%（68/141），在1985年至1992年期间显著降至35.8%（105/293）（OR为0.6，95%CI为0.4至0.9）。1977年至1984年期间严重ROP（双侧3至5期）的检出率为25.5%（36/141），1985年至1992年期间为17.7%（52/293），但下降幅度在统计学上不太显著（OR为0.6，95%CI为0.4至1.0）。总体上，仅4例（0.88%）幸存者因ROP导致双侧失明（每只眼睛视力低于6/60），每个时期各2例。
ELBW婴儿存活率的提高并不总是伴随着严重ROP或失明率的增加，至少对于一些大型三级中心出生的ELBW婴儿是这样。
