Screening Of Premature Infants With Retinopathy And Analysis Of Risk Factors

Background and objectivesRetinopathy of prematurity(ROP)is a vascular proliferative disease that affects retinal blood vessel development in preterm infants.Long-term vision outcomes caused by ROP include blindness and visual impairment.In recent years,advanced neonatal care has improved the survival rate of preterm infants,and the prevalence of ROP has gradually increased.Despite considerable progress in the treatment of ROP,a significant number of infants are blind each year due to ROP.Early identification and intervention of risk factors will be of great significance in preventing the occurrence of ROP.ROP is a multifactorial disease with multiple factors involved in the pathogenesis.In addition to the two recognized high-risk factors of low birth gestational age and low birth weight,a large number of literatures have reported other possible risk factors for ROP.However,due to regional differences,different research designs,and sample size limitations,consensus on some of its risk factors has not yet been reached.The purpose of this study is to investigate risk factors of ROP,to explore its possible pathogenesis,and to provide a theoretical basis for a more scientific and effective prevention of ROP.MethodsFrom May 2017 to April 2019,the preterm infants who were admitted to the neonatal intensive care unit of our hospital at birth and had been hospitalized for more than 2 weeks,gestational age ≤ 35 weeks,birth weight ≤ 2500 g and survive to complete retinal examination to correct gestational age at 45 weeks were selected as the study objects.The perinatal data were collected and divided into ROP group and non-ROP group according to the results of the retinopathy screening report.The indicators that may be related to ROP were first processed by univariate analysis,and then the indicators with statistical differences between the two groups were included in multivariate logistic regression analysis to find the risk factors of ROP.Results1.Prevalence of ROP and ROP that requires treatmentA total of 105 cases of ROP were detected in 1119 subjects,and the prevalence of ROP was 9.4%.Among them,there were 12 cases of pre-threshold lesion type 1 or threshold lesions,accounting for 1.07% of preterm infants screened.No stage IV or higher lesions were found.2.Results of ROP univariate analysisThe gestational age and birth weight of ROP group were 29.3(28.0,31.4)weeks and 1100(900,1550)g,respectively,significantly lower than that in non-ROP group(32.2(30.4,33.2)weeks and 1650(1350,2000)g,with statistically significant differences(Z values were 9.101 and 8.726,respectively,all P<0.001).All subjects were divided into different subgroups according to the gestational age and birth weight,and the incidence of ROP among each group was compared.It was found that the lower the gestational age and birth weight,the higher the prevalence of ROP,and the differences were statistically significant(all P<0.001).Placenta previa or abruption,Apgar scores at 1 minute and 5 minutes after birth,invasive ventilator time,total oxygen therapy time,intrauterine growth restriction,and NRDS,BPD,hyperglycemia,fungal infection,heart failure,anemia,agranulocytosis,abnormal blood coagulation,NEC,plasma NT-pro BNP levels on the7 th and 14 th days after birth were all factors related to ROP(all P<0.05).Gender,delivery mode,fetal number,fertilization way,maternal hypertension,gestational diabetes mellitus,hypothyroidism during pregnancy,anemia during pregnancy,amniotic fluid pollution,previous history of adverse pregnancy,antenatal corticosteroids treatment,maternal age,newborn Hypoglycemia,neonatal infection,hypoalbuminemia,white matter damage,and plasma NT-pro BNP levels on day 1 after birth were not significantly related to ROP(all P> 0.05).3.Results of ROP multivariate logistic regression analysisLow birth gestational age,low birth weight,placenta previa or abruption,total oxygen therapy time,intrauterine growth restriction,and plasma NT-pro BNP levels on day 14 after birth were all risk factors of ROP(OR values were 0.604,0.647,2.506,1.276,2.361,1.688,respectively,all P <0.05).Conclusions1.Low gestational age at birth,low birth weight,total oxygen therapy time and intrauterine growth restriction were risk factors of ROP.2.Maternal placenta previa or abruption and plasma NT-pro BNP levels on the14 th day after birth were all related to ROP,suggesting that intrauterine and extrauterine hemodynamic changes may be involved in the pathogenesis of ROP.