Todd D A, Kennedy J, Cassell C, Roberts S, John E
Department of Neonatology, Westmead Hospital, NSW, Australia.
J Paediatr Child Health. 1998 Feb;34(1):32-6. doi: 10.1046/j.1440-1754.1998.00149.x.
To study the effect of increased survival of infants <29 weeks' gestation on the incidence and severity of retinopathy of prematurity (ROP).
Review of prospective records from 1986 to 1992 kept in the New South Wales (NSW) NICUS database on infants admitted to the neonatal intensive care units (NICU) in NSW. The survival rate and the incidence and severity of ROP on all infants <29 weeks' gestation admitted to the NICUs in NSW from 1 July 1986 to 31 December 1987 were compared to a similar group of infants admitted from 1 January 1992 to 31 December 1992.
There was a significant difference in the survival rate of infants admitted between the two periods (235 of 376, 62.5% survival vs 255 of 336, 75.9% survival, respectively, P<0.0001). The odds ratio for survival adjusted for gestational age in the second period was 1.76 [1.24, 2.48 (95% confidence interval), P<0.002]. There was a slight increase in ROP in the second period (79 of 172 examined, 45.9% ROP vs 133 of 238 examined, 55.8% ROP, respectively). There was a rise in the number of infants with Stage 3 ROP in the second time period (14 of 172 examined, 8.1% ROP vs 41 of 238 examined, 17.2% ROP, respectively). However, fewer infants had detached retinas or > or = Stage 4 ROP in the second group [7 of 172, (4.1 %) vs 3 of 238, (1.3%), respectively]. This may be a reflection of the increase in the use of cryo- or laser therapy for Stage 3 ROP with 'plus' disease [2 of 172 examined, (1.2%) vs 18 of 238 examined, (7.6%), respectively].
With the increase in survival of the very preterm infant in recent years, there has been an increase in severe ROP (> or = Stage 3) in NSW. Despite the increased survival of the highest at-risk group (24- to 26-week gestation infants), there have been fewer cases of retinal detachment. There was also a rise in the number of infants receiving cryo- or laser therapy intervention.
研究孕龄小于29周的婴儿存活率提高对早产儿视网膜病变（ROP）发病率及严重程度的影响。
回顾新南威尔士州（NSW）新生儿重症监护病房（NICU）数据库中1986年至1992年的前瞻性记录。将1986年7月1日至1987年12月31日入住新南威尔士州NICU的所有孕龄小于29周婴儿的存活率、ROP发病率及严重程度，与1992年1月1日至1992年12月31日入住的一组类似婴儿进行比较。
两个时期入住婴儿的存活率存在显著差异（分别为376例中的235例，存活率62.5%；336例中的255例，存活率75.9%，P<0.0001）。第二个时期经孕龄调整后的存活比值比为1.76 [1.24, 2.48（95%置信区间），P<0.002]。第二个时期ROP略有增加（分别为检查的172例中的79例，ROP发生率45.9%；检查的238例中的133例，ROP发生率55.8%）。第二个时期3期ROP婴儿数量有所增加（分别为检查的172例中的14例，ROP发生率8.1%；检查的238例中的41例，ROP发生率17.2%）。然而，第二组中视网膜脱离或ROP≥4期的婴儿较少[分别为172例中的7例（4.1%）；238例中的3例（1.3%）]。这可能反映了对伴有“plus”病变的3期ROP使用冷冻或激光治疗的增加[分别为检查的172例中的2例（1.2%）；检查的238例中的18例（7.6%）]。
近年来，随着极早产儿存活率的提高，新南威尔士州严重ROP（≥3期）有所增加。尽管高危组（孕龄24至26周婴儿）存活率提高，但视网膜脱离病例减少。接受冷冻或激光治疗干预的婴儿数量也有所增加。
