Doğum Ağırlığı 1500 Gramın Üstündeki Preterm Yenidoğanlarda Retinopati Sıklığı

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

References

1. Referans1. Hellström A, Smith LE, Dammann O. Lancet 2013;26;382(9902):1445-57. doi: 10.1016/S0140-6736(13)60178-6.
2. Referans2. Dogra MR, Katoch D, Dogra M. An Update on Retinopathy of Prematurity (ROP). Indian J Pediatr 2017;84(12): 930-36.
3. Referans3. Lee AC. Katz J, Blencowe H, Cousens S, Kozuki N; CHERG SGA-preterm birth working group. National and regional estimates of term and preterm babies born small for gestational age in 138 low- income and middle-income countries in 2010. Lancet Glob Health 2013; 1(1): 26–36. doi: 10.1016/S2214-109X(13)70006-8
4. Referans4. Koç E, Yağmur Baş A, Özdek Ş, Ovalı F, Başmak H. Turkish Neonatal and Turkish Ophthalmology Societies consensus guideline on the retinopathy of prematurity. Turk Pediatri Ars 2018;53(Suppl 1): 151-60. doi: 10.5152/TurkPediatriArs.2018.01815
5. Referans5. International Committee for the Classification of Retinopathy of Prematurity. The international classification of retinopathy of prematurity. Arch Ophthalmol. 2005;123(7):991–9. doi: 10.1001/archopht.123.7.991.
6. Referans6. Gilbert CE. Screening for retinopathy of prematurity: does one size fit all? Arch Dis Child Fetal Neonatal Ed. 2016;101(4):F280–1. doi:10.1136/archdischild-2015-310129.
7. Referans7. Bas AY, Demirel N, Koc E, Ulubas Isık D, İrfanoğlu İM; on behalf of the TR-ROP Study Group. Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units. Br J Ophthalmol 2018;102:1711–1716.
8. Referans8. Bas AY, Koc E, Dilmen U, ROP Neonatal Study Group. Incidence and severity of retinopathy of prematurity in Turkey. Br J Ophthalmol 2015;99(10):1311-4. doi: 10.1136/bjophthalmol-2014-306286

9. Referans9. Fierson WM, American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2013;131(1):189–95. doi: 10.1542/peds.2012-2996
10. Referans10. Sharma D, Farahbakhsh N, Shastri S, Sharm P. Intrauterine growth restriction-part 2. J Matern Fetal Neonatal Med 2016;29(24):4037–48.
11. Referans11. Zubrow AB, Hulman S, Kushner H, Falkner B. Determinants of blood pressure in infants admitted to neonatal intensive care units: a prospective multicenter study. J Perinatol. 1995;15(6):470–9.
12. Referans12. Fierson WM; American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics 2018;142(6): e20183061. doi: 10.1542/peds.2018-3810.
13. Referans13. Gantz MG, Carlo WA, Finer NN, Rich W, Faix RG, SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Achieved oxygen saturations and retinopathy of prematurity in extreme preterms. Arch Dis Child Fetal Neonatal Ed 2020;105(2):138-44. doi: 10.1136/archdischild-2018-316464.
14. Referans14. Kim SJ, Port AD, Swan R, Campbell JP, Chan RVP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Surv Ophthalmol 2018;63(5): 618-37. doi: 10.1016/j.survophthal.2018.04.002.
15. Referans15. Smith LE, Hard AL, Hellström A. The biology of retinopathy of prematurity: how knowledge of pathogenesis guides treatment. Clin Perinatol 2013; 40:201–14.
16. Referans16. Chang JW. Risk factor analysis for the development and progression of retinopathy of prematurity. PLoS ONE 2019;14(7): e0219934. doi: 10.1371/journal.pone.0219934.
17. Referans17. Akkoyun I, Oto S, Yilmaz G, Gurakan B, Tarcan A, Anuk D, et al. Risk factors in the development of mild and severe retinopathy of prematurity. J AAPOS 2006; 10(5): 449–53. doi: 10.1016/j.jaapos.2006.05.007.
18. Referans18. Yau GS, Lee JW, Tam VT, Liu CC, Chu BC, Yuen CY. Incidence and risk factors for retinopathy of prematurity in extreme low birth weight Chinese infants. Int Ophthalmol 2015;35(3): 365-73. doi: 10.1007/s10792-014-9956-2.
19. Referans19. Motta MMS, Filho J, Coblentz, Amaral Fiorot C. Multiple pregnancies and its relationship with the development of retinopathy of prematurity (ROP). Clin Ophthalmol 2011;5:1783-7. Doi:10.2147/OPTH.S25431
20. Referans20. Darlow B, Cust A, Donoghue D. Improved outcomes for very low birthweight infants: evidence from a New Zealand national population-based data. Arch Dis Child Fetal Neonatal Ed 2003;88(1): F23-8. doi: 10.1136/fn.88.1.f23.
21. Referans21. Nugud AA, Nugud S, Nugud A, Nugud AA, Kathamuthu R, Jalal M. Perinatal risk factors for development of retinopathy of prematurity in a tertiary neonatal intensive care unit. J Taibah Univ Med Sci 2019;14(3):306-11. doi: 10.1016/j.jtumed.2019.05.001
22. Referans22. Mutangana F, Muhizi C, Mudereva G, Noë P, Musiime S; Rwanda Retinopathy of Prematurity Study Group. Retinopathy of prematurity in Rwanda: a prospective multi-centre study following introduction of screening and treatment services. Eye (Lond) 2020;34(5):847-56. doi: 10.1038/s41433-019-0529-5.
23. Referans23. Stutchfield C, Jain A, Odd D, Williams C, Markham R. Foetal haemoglobin, blood transfusion, and retinopathy of prematurity in very preterm infants: a pilot prospective cohort study. Eye 2017; 31(10): 1451e1455
24. Referans24. Yau GS, Lee JW, Tam VT, Liu CC, Chu BC, Yuen CY. Incidence and risk factors for retinopathy of prematurity in extreme low birth weight Chinese infants Int Ophthalmol 2015;35(3):365-73. doi: 10.1007/s10792-014-9956-2.
25. Referans25. Thomas K, Shah PS, Canning R, Harrison A, Lee SK, Dow KE. Retinopathy of prematurity: Risk factors and variability in Canadian neonatal intensive care units. J Neonatal Perinatal Med 2015;8(3):207-14. doi: 10.3233/NPM-15814128.
26. Referans26. Capozzi G, Santoro G. Patent ductus arteriosus: patho-physiology, hemodynamic effects and clinical complications. J Matern Fetal Neonatal Med. 2011;24(Suppl 1):15–6. doi: 10.3109/14767058.2011.607564.
27. Referans27. Polito A, Piga S, Cogo PE, Corchia C, Carnielli V, Da Fre` M, et al. Increased morbidity and mortality in very preterm / VLBW infants with congenital heart disease. Intensive Care Med 2013;39(6):1104–12. doi:10.1007/s00134-013-2887-y
28. Referans28. Razak A, Faden M. Association of small for gestational age with retinopathy of prematurity: a systematic review and meta-analysis. Arch Dis Child Fetal Neonatal Ed 2020;105(3):270-78. doi: 10.1136/archdischild-2019-316976.
29. Referans29. Kavurt S, Ozcan B, Aydemir O, Bas A, Demirel N. Risk of retinopathy of prematurity in small for gestational age premature infants. Indian Pediatr 2014;51(10): 804e806.
30. Referans30. Boghossian NS, Geraci M, Edwards EM, Horbar JD. Morbidity and mortality in small for gestational age infants at 22 to 29 weeks’ gestation. Pediatrics 2018;141(2): e20172533. doi: 10.1542/peds.2017-2533.
31. Referans31. Collaborative Study Group for Extremely Preterm & Extremely Low Birth Weight Infants, Collaborative Study Group for Extremely Preterm Extremely Low Birth Weight Infants. [The morbidities of extremely preterm and extremely low birth weight infants during hospitalization] (in chinese). Zhonghua Er Ke Za Zhi 2015;53:334–40.
32. Referans32. Giapros V, Drougia A, Krallis N, Theocharis P, Andronikou S. Morbidity and mortality patterns in small-for-gestational age infants born preterm. J Matern Fetal Neonatal Med 2012;25(2):153–7. doi: 10.3109/14767058.2011.565837
33. Referans33. Westby Wold SH, Sommerfelt K, Reigstad H, Rønnestad A, Medbø S, Farstad T, et al. Neonatal mortality and morbidity in extremely preterm small for gestational age infants: a population based study. Arch Dis Child Fetal Neonatal Ed 2009;94(5):F363–7. doi: 10.1136/adc.2009.157800.
34. Referans34. American Academy of Pediatrics Committee on Fetus and Newborn; American College of Obstetricians and Gynecologists Committee on Obstetric Practice. The Apgar Score. Pediatrics. 2015;136(4):819–22. doi: 10.1542/peds.2015-265