The Clinical Analysis On Screening Guidelines And Risk Factors Of Retinopathy Of Prematurity

Retinopathy of prematurity (ROP) is a kind of retinal proliferative lesion what happens in premature infants and very low birth weight infant (VLBWI), is a leading reason of childhood blindness in many high or middle income countries. Many people realized the development of ROP is impacted by milti-factors, and the incidence changed with interregional differences, but the mechanism of ROP has been not clear. With rapid socio-economic development and continuous improvement in the facilities and treatment during pregnancy and the neonatology technology, the survival rate of premature infants, especial very low birth weight infant (VLBWI) is increasing, in the end the incidence of ROP is ascending higher and higher.at present, ROP became the focus at home and abroad.Presently, many experts at home and abroad considered the incidence of ROP is related with gestational age (GA), birth weight (BW), the time and concentration of oxygen absorption, the mode of delivery,singleton or polyembryony, infection, the disease of respiratory system, blood transfusion, anaemia, the mode of feeding, gene mutation and so on. Thereinto, the relation of gestational age and birth weight are most consanguineous, but the relation of other influence factors is not certain. The fewer gestational age and birth weight, the higher incidence of ROP. Therefore, it is the fundamentality for the prevention of ROP to promote the health work for pregnant and lying-in women, which can decrease the natality of prematures infants and very low birth weight infants (VLBWI). The immature growth of retina is the precondition for ROP, else factors only promote the occurring and development of ROP in some specifical conditions. After prematures infants, especial very low birth weight infant (VLBWI) was born in case, we must prevent the occurring of ROP actively, and avoid any risk factor to the best of our abilities,such as the fluctuation of oxygen content in arterial blood and blood pressure, long-playing absorption of oxygen, the disease of respiratory system, nosocomial infection and so on.Now, there is no effective medicine to treat ROP clinically. At the present stage, the methods of treatment for ROP include condensation, Photocoagulation, operation and so on. if the ROP infants could be treated in time, its vision can get to become nomal. Consequently, the findings and treatment at early stage is very important for the prognosis of the prematurityies who suffered ROP. Nowdays, the screening guidelines of ROP are highly controversial, in different countries, even in the different regions of the same country, because of the marked differences of medical treatment level, economic level and the incidence of ROP, ophthalmologists and pediatricians should supplement and modify the nationwide-using screening guidelines flexibly to fit the need of screening in the local place. It is necessary for premature infants with high risk to extend the scope of screening,which can avoid the tremendous economic burden for families and social after the prematures infants who suffered ROP were not detected out. The objective of this study is to discuss the risk factors and nosogenic instance of ROP in jilin, in order to direct the clinical work.PURPOSE: to discuss the risk factors and nosogenic instance of retinopathy of prematurity (ROP) in changchun and its surrounding area, and discuss the high risk factors preliminaryly on the development of ROP in this population,and then summerise the screening guideline which is fit for the local place,in order to direct the clinical work.METHODS: We reviewed records from 214 consecutive infants with BW≤3750g, GA<37 weeks in neonatal intensive care unit (NICU) of jilin university from May, 2007 to Feberery, 2008, who were all birth in changchun and its surrounding area. We screen for ROP using RetCam II and binocular indirect ophthalmoscope, and record the state of optic fundi and relative data in detail. The diagnostic criterion is according to the international committee for the classification of retinopathy of prematurity (ICROP). The end of follow-up visit is that retina of prematures infants is vascularized absolutely.RESULTS: 1,56 prematures infants (109 eyes) catched ROP in the 214 cases, and the overall incidence of ROP was 26.4%. 21 infants had stage 1 ROP, 25 infants had stage 2 ROP, and 10 infants had stage 3 ROP. we haven't detected out stage 4, 5 ROP. 2,10 prematures infants catched ROP in the 40 twins and polyembryony cases, and the incidence of ROP was 27.5%, there was no marked qualitative difference between the singletons and polyembryonys (P>0.05). 3,35prematures infants catched ROP in the 129 male cases, and the incidence of ROP was 27.1%, 21 prematures infants catched ROP in the 85 female cases,and the incidence of ROP was 24.7%, there was no marked qualitative difference between the male and female infants(P>0.05). 4,2 prematures infants catched ROP in the 7 test-tube baby cases,and the incidence of ROP was 28.5%, there was no marked qualitative difference between the infants conceived naturally and those born after assisted conception (IVF) (P>0.05). 5,Hyperbilirubinemia, anaemia and congenital heart disease don't impact the incidence of ROP (P>0.05). 6,The incidence of ROP is related with gestational age (GA), birth weight (BW), the time of oxygen absorption notably, the fewer gestational age and birth weight, or the longer time of oxygen absorption, the higher incidence of ROP(P<0.001). 7,Infection, the disease of respiratory system and blood transfusion are related with the incidence of ROP(P<0.05). 8,There are most infants suffering stage 2 ROP in the ROP infants, least infants suffering stage 3 ROP. Those infants with stage 3 ROP had significantly lower BW and gestational age (GA). All they suffered from many kinds of complication, the time of oxygen absorption>20 days. 9,Most ROP infants (42 cases) are detected out when their corrective gestational age is 32~38 weeks,also most ROP infants are detected out after they has been born for 3~6 weeks. 10,The relevance ratio of RetCam II is higher than binocular indirect ophthalmoscope.CONCLUSIONS: 1,The overall incidence of ROP is 26.4% in this study. 2,The risk factors of ROP include gestational age (GA), birth weight (BW), the time of oxygen absorption, infection, the disease of respiratory system and blood transfusion. 3,Twins and polyembryonies, test-tube baby, hyperbilirubinemia, anaemia and congenital heart disease don,t impact the incidence of ROP. 4,Those infants with stage 3 ROP had significantly lower BW and gestational age (GA). All they suffered from many kinds of complication, the time of oxygen absorption>20 days. 5,Most ROP infants are detected out when their corrective gestational age is 32~38 weeks, also most ROP infants are detected out after they has been born for 3~6 weeks. 6,RetCam II is superior to binocular indirect ophthalmoscope. 7,We must carry the screening of ROP for the prematures infants with high risk in time, and propagandize the importance of the ROP screening actively. 8,The screening criteria at the moment is not unalterable, we can extend the scope of screening in some time, which can avoid missed diagnosis.