A Proposal of Screening Guideline for Retinopathy of Prematurity in Taiwan

在台灣早産兒視網膜病變篩檢之建議

江美治(Mei-Chih Chiang) ； 唐禎瑞(Jen-Ruey Tang) ； 鄒國英(Kuo-Inn Tsou) ； 楊中美(Chung-Mei Yang)

《Acta Paediatrica Taiwanica》 43卷4期 (2002/08) Pp. 204-207

https://doi.org/10.7097/APT.200208.0204

摘要

早産兒視網膜病變是早産兒最常見的合併症之一，美國小兒産醫學會最近提出新的篩檢原則，建議對於出生體重小於等於一千五百公克、或出生週數小於等於二十八週者，兒科醫師須於出生四至六週後照會眼科醫師執行眼底視網膜檢查；至於出生體重週數高於此標准的早産兒，則由兒科醫師決定是否檢查視網膜。令人感興趣的是，此一新建議可否適用於在台灣的醫學中心出生、接受醫療照護的早産兒。因此我們回溯近六年來出生於台大醫院、出生體重小於二千公克或出生週數小於三十五週的新生兒，其中共有617位曾接受視網膜血管檢查，結果有31(5.0%)們爲第一度視網膜病變，37(6.0%)位爲第二度視網膜病變，27(4.4%)位爲第三度視網膜病變，9(0.2%)位爲第四度視網膜病變。若改採美國小兒科醫學會最近提出的新篩檢原則，在617位早産兒中雖節省約一半的檢查人次，卻將因此錯過八位第一痊視網膜病變和五位第二度視網膜病變；若把篩檢標准提高至三十一週，則不會錯過任何第二度及以上的視網膜病變，並可節省37%的篩檢人次。因此我們建議以下的篩檢原則：出生於台灣的醫學中心、出生體重小於等於一千五百公克或出生週數小於等於三十一週的早産兒，不論出生的狀況，皆必須於出生後四至六週時接受眼底視網膜檢查，至於出生體重週數高於此標准的早産兒，則視臨床狀況決定是否檢查視網膜。相對於本院目前對早産兒視網膜病變的篩檢原則，此新策略將有助於節省醫療開支。

關鍵字

早産兒視網膜病變

並列摘要

Retinopathy of prematurity (ROP) is one of the most important morbidity in premature infants. The latest American Academy of Pediatrics (AAP) screening guidelines for ROP are mandatory for infants with birth weights≦1500 g or gestational ages (GA)≦28 weeks. To determine the appropriate upper limits for ROP screening in Taiwan in terms of birth weight and gestational age, we performed a retrospective review of all 617 infants who were born at the National Taiwan University Hospital from January 1, 1994 to December 31, 1999, and survived beyond 28 days of life and received eye-ground evaluation under our current ROP screening guidelines. From the start of our study, the criteria for screening was birth weight＜2000 g or gestational age＜35 weeks . The maximal stage of retinopathy observed was recorded. We found no ROP greater than stage 1 in infants with birth weights＞1500g and GA＞31 weeks. In comparing with our current guidelines, lowering the screening criteria to birth weight≤1500g or gestational age≦3l weeks reduced the number of infants requiring screening by 37.2%, while no case of ROP greater than stage 1 was missed. However five cases of stage 2 ROP would have been missed in our study f the gestational age cut-off was≤28 weeks as recommended by AAP. Therefore, we recommend that in the tertiary nursery in Taiwan, the gestational age≤3l weeks or birth body weight≦1500 g should be screened for ROP regardless of clinical condition. The screening for larger infants with high risk of ROP requires further discretion of the attending physicians.

並列關鍵字

retinopathy of prematurity (ROP)