Wright K, Anderson M E, Walker E, Lorch V
Department of Pediatrics, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA.
Pediatrics. 1998 Jul;102(1 Pt 1):31-4. doi: 10.1542/peds.102.1.31.
To determine appropriate upper limits for gestational age and birth weight when screening infants for retinopathy of prematurity (ROP).
Retrospective survey.
Tertiary neonatal intensive care nursery.
Seven hundred seven infants born July 1, 1990 to June 30, 1996 and screened for ROP according to the 1988 to 1996 American Academy of Pediatrics guidelines.
Maximum stage of ROP with respect to birth weight and gestational age.
No ROP more than Stage 1 was observed in infants with gestational ages >/=32 weeks or birth weights >/=1500 g. All cases of threshold and Stage 4 ROP were confined to infants with gestational ages </=30 weeks or birth weights <1200 g.
The latest American Academy of Pediatrics screening guidelines for ROP are discretionary for infants with birth weights >1500 g or gestational ages >28 weeks. If ROP screening is limited to infants with birth weights of </=1500 g, 34.2% fewer infants would require screening compared with the previous <1800 g recommendation, while missing no cases of ROP more than Stage 1. A gestational age cut-off of </=28 weeks, however, is less desirable, and could potentially miss several infants with more advanced retinopathy (including Stage 4). If ROP screening criteria were instead modified to include infants of gestational ages <32 weeks, the number of patients requiring screening could be reduced 29.1% compared with the previous recommendation of <35 weeks, again without missing any cases of ROP more than Stage 1. Use of such a screening strategy (birth weight <1500 g or gestational age <32 weeks) is predicted to save in excess of 1.5 million dollars annually in the United States, while missing no cases of ROP more than Stage 1.
确定对早产儿视网膜病变(ROP)进行筛查时,合适的胎龄和出生体重上限。
回顾性调查。
三级新生儿重症监护病房。
1990年7月1日至1996年6月30日出生并根据1988年至1996年美国儿科学会指南接受ROP筛查的707名婴儿。
ROP相对于出生体重和胎龄的最大分期。
胎龄≥32周或出生体重≥1500g的婴儿中未观察到超过1期的ROP。所有阈值ROP和4期ROP病例均局限于胎龄≤30周或出生体重<1200g的婴儿。
对于出生体重>1500g或胎龄>28周的婴儿,美国儿科学会最新的ROP筛查指南可酌情使用。如果将ROP筛查限于出生体重≤1500g的婴儿,与之前<1800g的建议相比,需要筛查的婴儿数量将减少34.2%,同时不会漏诊超过1期的ROP病例。然而,胎龄截止值≤28周不太理想,可能会漏诊几名患有更晚期视网膜病变(包括4期)的婴儿。如果将ROP筛查标准改为包括胎龄<32周的婴儿,与之前<35周的建议相比,需要筛查的患者数量可减少29.1%,同样不会漏诊超过1期的ROP病例。预计在美国使用这种筛查策略(出生体重<1500g或胎龄<32周)每年可节省超过150万美元,同时不会漏诊超过1期的ROP病例。