Doğum Ağırlığı 1500 Gramın Üstündeki Preterm Yenidoğanlarda Retinopati Sıklığı

Year 2021, , 208 - 215, 25.05.2021

Hakan Ongun , Seçil Özdemir Şahin Mehmet Tahir Şam Onursal Gözkaya Sariye Elif Özyazıcı Özkan

https://doi.org/10.12956/tchd.783448

Abstract

Amaç: Doğum ağırlığı (DA) 1500 gram ve üstündeki yenidoğanlarda prematüre retinopatisi (ROP) sıklığının ve risk faktörlerinin değerlendirilmesi.

Gereç ve Yöntemler: Retrospektif, tek-merkezli, kohort olarak planlanan çalışmaya 2010-2019 yıllarında yoğun bakıma yatırılan ve ROP taraması yapılan preterm yenidoğanlar alındı. Doğum ağırlığı <1500 gram, konjenital anomalisi olan, tarama öncesi kaybedilen, dış merkeze yönlendirilenler çalışma dışı bırakıldı. Olguların maternal-neonatal özellikleri, klinik verileri, retinopati-tarama bulguları (evre, bölge, plus-hastalık), uygulanan tedaviler kaydedildi. Çoklu regresyon analiziyle ROP gelişimindeki risk faktörleri değerlendirildi.

Bulgular: Genel ROP insidansı 1431 yenidoğanda %7.6 bulundu. En büyüklerini 36. gebelik haftasında doğan 2450 gram ağırlığındaki pretermin oluşturduğu retinopati olgularının doğum ağırlığına göre sıklığı 1500–1599 gr: %17.1; 1600–1699 gr: %13.8; 1700–1799 gr: %8.8; 1800–1899 gr: %8.2; 1900–1999 gr: %2.9; ≥2000 gr: %1.3 bulundu. Gestasyonel haftasına göre DA 10 persentilin altında doğum (SGA; OR: 2.52, %95CI: 1.48-4.30), neonatal resusitasyon ihtiyacı (OR:3.23, %95 CI: 1.87-5.57), Apgar düşüklüğü (OR:2.08, %95 CI: 1.03-4.20), kalp hastalığı (OR:2.25, %95CI: 1.38-3.69), hemodinamik bozukluk (OR:3.67, %95 CI: 1.92-7.02), intraventriküler hemoroji (OR: 2.86, %95 CI:1.40-5.86) varlığıyla retinopati gelişimi arasında ilişki saptandı. Çoklu regresyon analizinde uzamış mekanik ventilasyon (>2 gün) ve oksijen desteğinin (>9 gün) en yüksek olasılığı veren bağımsız risk faktörleri olduğu saptandı (OR:8.79, %95 CI: 5.53-13.99; OR: 4.67, %95 CI: 2.26-9.66). Yirmi iki (%1.5) hastada tedavi ihtiyacı doğdu (Tip-1 hastalık: onsekiz hastada, agresif-ROP: dört hastada). Doğum kilosu 1800 gram ve üstündeki beş bebekte tedavi ihtiyacı doğdu.

Sonuç: Doğum ağırlığı 1500 gram ve üstündeki bebeklerde retinopati %7.6, tedavi ihtiyacı %1.5 sıklığındadır. Neonatal resusitasyon, SGA, intraventriküler hemoroji, uzamış solunum ve mekanik ventilasyon desteği, kalp hastalığı, inotrop ihtiyacı gösteren hemodinamik bozukluklar retinopati gelişimini artıran risk faktörleridir.

Keywords

İntravitreal enjeksiyonlar, Fotokoagülasyon, Prematürite retinopatisi, Risk faktörleri

Retinopathy in the Preterm Infant Born Over 1500 grams

Abstract

Objective: To investigate the incidence of retinopathy of prematurity (ROP) and assess risk analysis in infants of birth weight (BW) ≥1500 grams.

Material and Methods: Retrospective, single-center, cohort included preterm intensive-care admissions who were screened for ROP between 2010-2019. Exclusion criteria were BW <1500 grams, congenital anomalies, death or postnatal transfers before ROP-screening. Data were extracted for maternal/neonatal characteristics, clinical features, retinopathy’s grade–zone, plus-disease and treatment. Multivariate regression analysis determined risk factors for developing retinopathy.

Results: ROP incidence was 7.6% in 1431 infants with the largest-one born 2450 grams at 36th gestational weeks (BW between 1500–1599 gr: 17.1%, 1600–1699 gr: 13.8%, 1700–1799 gr: 8.8%, 1800–1899 gr: 8.2%, 1900–1999gr: 2.9%, ≥2000 gr: 1.3%). Small for gestational age (SGA; OR:2.52, 95% CI:1.48-4.30), neonatal resuscitation (OR:3.23, 95% CI:1.87-5.57), low Apgar score (OR:2.08, 95% CI:1.03-4.20), congenital heart disease (OR:2.25, 95% CI:1.38-3.69), hemodynamic instability (OR:3.67, 95% CI:1.92-7.02), intraventricular hemorrhage (OR:2.86, 95% CI:1.40-5.86) were associated with ROP. In the multivariate logistic regression, prolonged mechanical ventilation (duration >2 days) and oxygen supplement (duration >9 days) were identified as independent risk factors that presented highest odds for retinopathy (OR:8.79, 95% CI: 5.53-13.99 and OR:4.67, 95% CI: 2.26-9.66). Therapy was warranted in 22 (1.5%) neonates (Type-1 ROP in eighteen, aggressive-ROP in four patients). Four infants with BW ≥1800 grams delivered ROP-treatment.

Conclusion: ROP incidence is 7.6% and treatment-warranted retinopathy is 1.5% in neonates born ≥1500 grams. Preterm-infants with SGA, neonatal resuscitation, congenital heart disease and hemodynamic instability requiring inotropes, intraventricular hemorrhage and the ones necessitating prolonged mechanical ventilation and oxygen supplement are more likely to develop ROP.

Keywords

Intravitreous injections, Photocoagulation, Retinopathy of prematurity, Risk factors

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