Prematüre Retinopatisi: Temel Belirleyicilerin Dışındaki Etkenler

Öz

Amaç: Bu çalışmada, prematüre retinopatisi (ROP) gelişen ve gelişmeyen bebeklerde maternal ve neonatal risk faktörlerini karşılaştırarak, ROP gelişimi ile ilişkili bağımsız belirleyicilerin ortaya konulması amaçlandı.

Materyal ve metod: 1 Ocak 2022-31 Aralık 2024 tarihleri arasında Yenidoğan Yoğun Bakım Ünitemizde izlenen, gebelik haftası ≤34 olan 277 prematüre bebek retrospektif olarak değerlendirildi. Olgular ROP gelişen (n=89) ve gelişmeyen (n=188) olmak üzere iki gruba ayrıldı. Maternal [(preeklampsi, koryoamniyonit (CA)] ve neonatal (gebelik haftası, doğum ağırlığı, Apgar skorları, surfaktan tedavisi ve patent duktus arteriozus [PDA]) parametreler karşılaştırıldı. ROP gelişimi ile ilişkili bağımsız faktörleri belirlemek amacıyla çok değişkenli lojistik regresyon analizi yapıldı.

Bulgular: ROP gelişen grupta ortalama gebelik haftası (28,8±2,3 vs. 31,3±1,4 hafta; p<0,001) ve doğum ağırlığı (1077,1±287,3 g vs. 1492,7±341,7 g; p<0,001) anlamlı derecede daha düşüktü. Doğum boyu, baş çevresi ve 1. ile 5. dakika Apgar skorları da ROP grubunda daha düşüktü (tümü p<0,001). Univaryant analizlerde surfaktan gereksinimi (p=0,004), PDA sıklığı (p=0,041), maternal preeklampsi (p=0,005) ve CA (p=0,032) ROP gelişen olgularda daha yüksek bulundu. Çok değişkenli lojistik regresyon analizinde ise yalnızca düşük gebelik haftası [olasılık oranı (OO)=0,569; %95 güven aralığı (GA): 0,443-0,724; p<0,001)], düşük doğum ağırlığı (OO=0,998; %95 GA: 0,997-1,000; p=0,014) ve maternal preeklampsi (OO=2,770; %95 GA: 1,360-5,842; p=0,005) ROP gelişimi ile bağımsız olarak ilişkili bulundu.

Sonuç: Prematürite derecesi ve düşük doğum ağırlığı ROP gelişiminin temel belirleyicileri olmaya devam etmektedir. Bununla birlikte maternal preeklampsi, gebelik haftası ve doğum ağırlığından bağımsız olarak ROP gelişimi ile ilişkili bulunmuştur. Diğer neonatal faktörler ROP gelişimi ile ilişkili görünmekle birlikte, bu ilişkinin prematüritenin derecesi ile ilişkili olabileceği düşünülmektedir. Bu bulgular, yüksek riskli bebeklerin belirlenmesinde perinatal faktörlerin bütüncül değerlendirilmesinin önemini göstermektedir.

Anahtar Kelimeler

• Prematüre retinopatisi
• preeklampsi
• patent duktus arteriozus

Retinopathy of Prematurity: Factors Beyond the Basics

Öz

Background: This study aimed to compare maternal and neonatal risk factors between infants with and without retinopathy of prematurity (ROP) and to identify independent determinants associated with ROP development.

Materials and Methods: A total of 277 premature infants with a gestational age ≤34 weeks who were followed in our neonatal intensive care unit between January 1, 2022, and December 31, 2024, were retrospectively evaluated. The infants were divided into two groups: those who developed ROP (n=89) and those who did not (n=188). Maternal (preeclampsia, chorioamnionitis) and neonatal (gestational age, birth weight, Apgar scores, surfactant therapy, and patent ductus arteriosus [PDA]) parameters were compared. Multivariate logistic regression analysis was performed to determine independent factors associated with ROP development.

Results: The mean gestational age (28.8±2.3 vs. 31.3±1.4 weeks; p<0.001) and birth weight (1077.1±287.3 g vs. 1492.7±341.7 g; p<0.001) were significantly lower in the ROP group. Birth length, head circumference, and 1- and 5-minute Apgar scores were also significantly lower in infants with ROP (all p<0.001). In univariate analyses, the need for surfactant therapy (p=0.004), the frequency of PDA (p=0.041), maternal preeclampsia (p=0.005), and chorioamnionitis (p=0.032) were higher in the ROP group. In multivariate logistic regression analysis, only lower gestational age [odds ratio (OR)=0.569; 95% confidence interval (CI): 0.443-0.724; p<0.001)], lower birth weight (OR=0.998; 95% CI: 0.997-1.000; p=0.014), and maternal preeclampsia (OR=2.770; 95% CI: 1.360-5.842; p=0.005) remained independently associated with ROP development.

Conclusions: The degree of prematurity and low birth weight remain the primary determinants of ROP development. Additionally, maternal preeclampsia was found to be independently associated with ROP development beyond gestational age and birth weight. Other neonatal factors appeared to be associated with ROP; however, these associations may largely reflect the degree of prematurity. These findings highlight the importance of a comprehensive perinatal assessment for identifying high-risk infants.

Anahtar Kelimeler

• Retinopathy of prematurity
• preeclampsia
• patent ductus arteriosus

Kaynakça

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