Retinopathy of Prematurity in Very-Low-Birthweight Neonates: Epidemiology and Risk Factors

在回溯性的研究中共有143位極低出生體重兒被研究，其中138位有完整的資料可供整理，他們均在出生後四到六周內由接受過視綱膜專門訓練的眼科醫師檢查眼底。第個個案均有三十四項產前與產後的重要因素被登錄當成自變項，以視網膜病變的發生、視網膜病變的嚴重程度及閾值視網膜病變作為應變項來分析。我們發現視網膜病變的發生率為18.8%，出生體重低於1000公克的早產兒的發生率為44.9%，閾值視網膜病變的發生率為3.6%，所有閾值視網膜病變都發生在出生體重低1000公克的早產兒。在多變項分析中使用持續性呼吸道正壓治療的天數與視網膜病變的發生有關；使用持續性呼吸道正壓治療天數、血清膽紅素值及血清直接膽紅素值與視網膜病變的嚴重度有關；細菌性敗血症與閾值高網膜病變的發生有關。在我們研究中發現，防範細菌性敗血症的發生可能是預防閾值視網膜病變的最好方法。

關鍵字

早産兒視綱膜病變；極低出生體重；閾症

並列摘要

A retrospective study of 143 very-Iow-birthweight infants cared in a level Ⅲ neonatal intensive care unit who had survived for at least 28 days. Initial eye ground evaluation was done at the postnatal age between 4 and 6 weeks. Follow-up evaluation was done every one to two weeks at the discretion of the ophthalmologists. Thirty-four variables were reviewed for each case. Statistical analysis was done for each variable, with the development of retinopathy of prematurity (ROP), severity of ROP and development of threshold ROP as the dependent variables, by Mann-Whitney U test or X^2 test when adequate. Variables with P-valu＜0.05 were included in multiple regression. One hundred and thirty-eight cases were survived for more than 28 days with their eyes been checked. Twenty-six (18.8%) of them developed ROP. The prevalence of stage Ⅰ was 2.2% (3/138), stage Ⅱ was 3.6% (5/138), stage Ⅲ was 12.3% (17/138), and stage V was 0.7% (1/138). Threshold disease, stage 3 (+) and above, was found in 5 cases (3.6%). Seventeen variables were found to be correlated with the development of ROP. Only the duration of continuous positive airway pressure (CPAP) was significntly correlated to the development of ROP in multivariate logistic regression. Fifteen variables were correlated with the severity of ROP, but only peak direct bilirublin level, peak total bilirubin level and duration of CPAP could entered multiple stepwise linear regression. Thirteen variables were correlated with the development of threshold ROP, but only episodes of septicemia enter the multivariate logistic regression. We postulate that the longer duration of CPAP in ROP cases may reflect the severity of apnea and episodes of hypoxic attacks. Reducing episodes of apnea may prevent the development of ROP. The number of episodes of septicemia was the only significant variable for threshold ROP so that infection control is important for the prevention of threshold disease.

並列關鍵字

retinopathy of prematurity ； very-low-birthweight ； threshold disease

國際替代計量

Retinopathy of Prematurity in Very-Low-Birthweight Neonates: Epidemiology and Risk Factors

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