Prematüre Retinopatisi Sıklığı ve Risk Faktörlerinin Değerlendirilmesi

Öz

Amaç: Prematüre retinopatisi (PR) sıklığı ve risk faktörlerinin belirlenmesi

Gereç ve Yöntemler: Dört yıllık sürede (1 Ocak 2011 - 27 Aralık 2014) yenidoğan yoğun bakım ünitemizde takip edilen, gebelik yaşı ≤ 32 hafta veya doğum ağırlığı ≤ 1500 g 888 preterm yenidoğanın PR tarama sonuçları geriye dönük olarak değerlendirildi. Tedavi alan ve almayan pretermlerin verileri Student T ve Ki kare testleri ile karşılaştırıldı. PR tedavisi için anlamlı bulunan değişkenler bağımsız risk faktörleri açısından lojistik regresyon analizi ile değerlendirildi.

Bulgular: PR saptanan 386 hastanın ortalama gebelik yaşı 28.6 ± 1.9 hafta ve doğum kilosu 1085 ± 287 g, PR olmayan 502 hastanın ise 30.3 ± 1.7 hafta ve 1413 ± 298 g bulundu. PR oranı % 43 saptandı. PR olan hastalar, tedavi alanlar ve almayanlar şeklinde incelendiklerinde; tedavi alan 114 (% 29.5) hastanın ortalama gebelik yaşı 27.43 ± 2.03 hafta ve doğum kilosu 969 ± 276 g, tedavi almayan 272 (% 70.5) hastanın ise 29.07 ± 1.73 hafta ve 1134 ± 278 g bulundu. Tekli oran karşılaştırılmalarında gebelik yaşı, doğum ağırlığı, erkek cinsiyet, antenatal steroid yokluğu, koryoamniyonit, respiratuar distres sendromu, inotrop kullanımı, eritrosit transfüzyonu, sepsis, patent duktus arteriosus, intraventriküler kanama ve toplam oksijen verilme süreleri farklı bulundu. Lojistik regresyon analizinde ise gebelik yaşı [Relative risk (RR): 0.74, % 95 Confidence interval (Cİ): 0.63 - 0.87], erkek cinsiyet (RR: 1.9, % 95 Cİ: 1.14 - 3.17) ve eritrosit transfüzyonu (RR: 2.52, % 95 Cİ: 1.3 - 4.9) bağımsız risk faktörleri olarak tespit edildi.

Sonuç: Aşırı preterm yenidoğanların sağ kalımlarındaki artış nedeniyle prematüre retinopatisi sıklığı önemli bir sorun olmaya devam etmektedir. Etkili risk faktörlerinin azaltılması ile retinopati morbiditesi azaltılabilir.

Anahtar Kelimeler

• Prematüre retinopatisi,preterm yenidoğan

Evaluation of the Incidence and Risk Factors of Retinopathy of Prematurity

Öz

Aim: To evaluate the incidence and risk factors of retinopathy of prematurity (ROP)

Materials and Methods: Results of ROP screening of the four years period (from 1 January 2011 to 27 December 2014) were assessed retrospectively. Data of preterm newborns with and without intervention for ROP were compared with statistics of Student T and Ki square tests. Variables that are found significant for ROP with intervention were examined with logistic regression analysis in term of independent risk factors.

Results: ROP was detected in 386 preterms with a mean gestational age of 28.6 ± 1.9 weeks and birth weight of 1085 ± 287 and patients without ROP with a mean gestational age of 30.3 ± 1.7 weeks and birth weight of 1413 ± 298, respectively. The overall incidence of ROP was 43.4 %. Patients with ROP were grouped into with and without intervention; 114 preterms with intervention (29.5 %) had a mean gestational age of  27.43 ± 2.03 weeks and birth weight 969 ± 276 g and 272 preterms without intervention (70.5 %) had a mean gestational age of  29.07 ± 1.73 weeks and birth weight 1134 ± 278 g. Male gender, the absence of antenatal steroid, chorioamnionitis, respiratory distress syndrome, inotrope use, erythrocyte transfusion, sepsis, patent ductus arteriosus, intraventricular hemorrhage, and total oxygen use were found significantly higher in the preterms with intervention than the preterms without intervention. On the contrary, gestational age and birthweight birth weight were found significantly lower in the preterms with intervention. Gestational age, male gender, and erythrocyte transfusion were identified as independent risk factors.

Discussion and Conclusion: ROP remains a crucial issue in excessively preterm newborns that have increased survival rates. Reduction of risk factors may decrease morbidity of ROP.

Anahtar Kelimeler

• Retinpathy of prematurity,preterm newborn

Kaynakça

1. 1. Terry TL. Extreme prematurity and fibroblastic overgrowth of persistent vascular sheath behind each crystalline lens. I. Preliminary report. Am J Ophthalmol. 1942;25:203-4.
2. 2. Steinkuller PG, Du L, Gilbert C, et al. Childhood blindness. JAAPOS. 1999;3(1):26-32.
3. 3. Palmer EA, Flynn JT, Hardy RJ, et al. Incidence and early course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology. 1991;98:1628-40.
4. 4. Chawla D, Agarwal R, Deorari A, et al. Retinopathy of prematurity. Indian J Pediatr. 2012;79(4):501-9.
5. 5. Gilbert C, Fielder A, Gordillo L, et al. ; International NO-ROP Group. Characteristics of infants with severe retinopathy of prematurity in countries with low, moderate, and high levels of development: implications for screening programs. Pediatrics. 2005;115(5):518-25.
6. 6. Hungi B, Vinekar A, Datti N, et al. Retinopathy of Prematurity in a rural Neonatal Intensive Care Unit in South India-a prospective study. Indian J Pediatr. 2012;79(7):911-5.
7. 7. Akçakaya AA, Yaylali SA, Erbil HH, et al. Screening for retinopathy of prematurity in a tertiary hospital in Istanbul: incidence and risk factors. J Pediatr Ophthalmol Strabismus. 2012;49(1):21-5.
8. 8. Küçükevcilioğlu M, Mutlu FM, Sarıcı SU, et al. Frequency, risk factors and outcomes of retinopathy of prematurity in a tertiary care hospital in Turkey. Turk J Pediatr. 2013;55(5):467-74.

9. 9. Bas AY, Demirel N, Koc E, et al. ; 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 Mar 8. pii: bjophthalmol-2017-311789. doi:10.1136/bjophthalmol-2017-311789. [Epub ahead of print] PubMed PMID: 29519879.
10. 10. Young TL, Anthony DC, Pierce E, et al. Histopathology and vascular endothelial growth factor in untreated and diode laser-treated retinopathy of prematurity. J AAPOS. 1997;1:105-10.
11. 11. Pierce EA, Foley ED, Smith LE. Regulation of vascular endothelial growth factor by oxygen in a model of retinopathy of prematurity. Arch Ophthalmol. 1996;114:1219-28.
12. 12. Hellstrom A, Perruzzi C, Ju M, et al. Low IGF-I suppresses VEGF-survival signaling in retinal endothelial cells: direct correlation with clinical retinopathy of prematurity. Proc Natl Acad Sci USA. 2001;98:5804-8.
13. 13. International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123:991-9.
14. 14. Early Treatment For Retinopathy Of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol. 2003;121(12):1684-94.
15. 15. Papile LA, Burstein J, Burstein R, et al. Incidence and evolution of the subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr. 1978;92:529-34.
16. 16. Walsh M, Kliegman RM. Necrotizing enterocolitis: treatment based on staging criteria. Pediatr Clin North Am. 1986;33:179-201.
17. 17. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med. 2001;163:1723-9.
18. 18. Painter SL, Wilkinson AR, Desai P, et al. Incidence and treatment of retinopathy of prematurity in England between 1990 and 2011: database study. Br J Ophthalmol. 2015;99:807-11.
19. 19. Hussain N, Clive J, Bhandari V. Current incidence of retinopathy of prematurity, 1989-1997. Pediatrics. 1999;104:e26.
20. 20. Good WV, Hardy RJ, Dobson V, et al. The incidence and course of retinopathy of prematurity: findings from the early treatment for retinopathy of prematurity study. Pediatrics. 2005;116:15-23.
21. 21. Darlow BA, Hutchinson JL, Henderson-Smart DJ, et al. Prenatal risk factors for severe retinopathy of prematurity among very preterm infants of the Australian and New Zealand Neonatal Network. Pediatrics. 2005;115:990-6.
22. 22. Kavurt S, Yücel H, Hekimoğlu E, et al. Prematüre retinopatisi gelişen olgularda risk faktörlerinin değerlendirilmesi. Çocuk Sağlığı ve Hastalıkları Dergisi. 2012; 55:125-31.
23. 23. Sarikabadayi YU, Aydemir Ö, Özen ZT, et al. Screening for Retinopathy of Prematurity in a Large Tertiary Neonatal Intensive Care Unit in Turkey: Frequency and Risk Factors. Ophthalmic Epidemiology. 2011;18(6):269-74.
24. 24. Özbek E, Genel F, Atlıhan F, et al. Yenidoğan yoğun bakım ünitemizde prematüre retinopatisi insidansı, risk faktörleri ve izlem sonuçları. İzmir Dr. Behçet Uz Çocuk Hast Dergisi. 2011;1(1):7-12.
25. 25. Seiberth V, Linderkamp O. Risk factors in retinopathy of prematurity. a multivariate statistical analysis. Ophthalmologica. 2000;214(2):131-5.
26. 26. Hagadorn JI, Richardson DK, Schmid CH, et al. Cumulative illness severity and progression from moderate to severe retinopathy of prematurity. J Perinatol. 2007;27:502-9.
27. 27. Kaempf JW, Kaempf AJ, Wu Y, et al. Hyperglycemia, insulin and slower growth velocity may increase the risk of retinopathy of prematurity. J Perinatol. 2011;31:251-7.
28. 28. Löfqvist C, Hansen-Pupp I, Andersson E, et al. Validation of a new retinopathy of prematurity screening method monitoring longitudinal postnatal weight and insulin-like growth factor I. Arch Ophthalmol. 2009;127:622-7.
29. 29. Bharwani SK, Dhanireddy R. Systemic fungal infection is associated with the development of retinopathy of prematurity in very low birth weight infants: a meta-review. J Perinatol. 2008;28:61-6.