Postnatal Weight Gain And Associated Risk Factors Of Retinopathy Of Prematurity

Retinopathy of Prematurity is the immature preterm or low birth weight infants retinal proliferative diseases, mainly due to immature retinal development is not perfect cause. The occurrence of ROP is the common action of many factors lead to vascular abnormalities, currently recognized risk factors of premature delivery, low birth weight and no rational oxygen therapy. With the development of neonatal medicine and improve the level of neonatal treatment, survival rate of premature infants increased year by year, the incidence rate of ROP will increase accordingly. At present, the retinopathy of prematurity has become a worldwide leading cause of blindness in children. Premature infants conventional eyeground screening can detect abnormal retinal lesions, for severe ROP early retinal photocoagulation or condensation can be prevented retinal disease development, so that children have a relatively good prognosis of visual acuity. But conventional fundus screening increased preterm infant pain index, and most children with screening for negative or not need treatment. Therefore, to understand the incidence of ROP is a number, ROP risk factors, how to effectively carry out ROP screening and prevention problem becomes national efforts to solve difficult research key, how to pass the postnatal factors, a reasonable assessment of ROP may occur, not omission in severe ROP patients, how to narrow the scope of eyeground screening, is problems need to be solved at present. This article on the pediatric department of Paediatrics Hospital Affiliated to Fudan University in newborn preterm infants may risk factors related with ROP analysis, study of ROP incidence, risk factors, after birth weight in predicting the correlation between ROP, ROP occurs to provide for clinical prevention strategies, in order to further improve the survival of premature infants treated withPart Ⅰ:The High Risk Factors of Retinopathy of Prematurity Objective:To analyz the common high risk factors of ROP.Methods:Retrospective analysis of2002.1.1～2011.12.31the Children’s Hospital of Fudan University NICU admission, and meet the ROP screening criteria(gestational age<34weeks, birth weight<2000g of premature infants), Exclusion criteria:(1)the outer courtyard confirmed ROP cases;(2) treatment is unknown, on other hospital. Ophthalmologie exminafions were started at4weeks after delivery until resolution or retinal maturation. Each unit collected clinical datas and final examination result. Including:gender, multiple-births, fetal distress, asphyxia, use of prenatal steroids, surfactant usage, apnea, oxygen time, anemia, blood transfusion, acidosis, PDA, sepsis, NEC, hyperbilirubinemia, cholestasis, SGA, GA and BW. Analyzed the data with using statistical software SPSS19.0, and recorded the data by XDd±S. Analyzed the ROP correlation of sole risk factors by x2test, while the relevance of multiple risk factors and ROP by Logistic regression analysis. P<0.01has statistical significance.Results:According to inclusion criteria a total of1087cases of premature infants into standard. Gestational age is24-40.5weeks (30.85±2.38weeks), birth weight600-2840g (1455.61±307.28g), in all1087subjects inclusion criteria, including213cases of ROP, incidence rates of ROP is19.59%. By univariate analysis, birth weight, gestational age, asphyxia, oxygen, apnoea, surfactant usage, acidosis, blood transfusion, hyperbilirubinemia, cholestasis, and SGA were associated with ROP(p<0.05). Logistic regression analysis showed that birth weight, gestational age, apnoea, surfactant usage, hyperbilirubinemia, cholestasis were independent factors.Conclusions:Retinopathy of prematurity and the incidence of a variety of factors related to prematurity are the root causes of ROP prevention of prematurity and reduce extremely premature infants born in the prevention of ROP are fundamental. Prevention and treatment of various complications, reasonable ROP oxygen therapy are the key to prevention.Part11:Postnatal weight gain as a predictor of Retinopathy of prematurityObjective:To analyze relative weight gain among4weeks after birth in order to predict the development of retinopathy of prematurity.Methods:A retrospective study between2008and2011from Children’s Hospital of Fudan University. Meet the ROP screening criteria(gestational age<34weeks, birth weight<2000g of premature infants,exclusion criteria (1) outside of the hospital treatment is unknown;(2) the outer courtyard confirmed ROP cases;(3) with severe congenital malformations that met the inclusion criteria of preterm infants;(4) congenital cause weight growth abnormalities of the disease;(5) weight missing points more than three. Analyzed the data with using statistical software SPSS19.0, non-parametric tests were used to analyze continuous variables. Chi-square test was used to compare categorical variables. Statistical significance was accepted p<0.05. Two different logistic regression models were used. In the first model BW, GA,relative weight gain at second and fourth week of life were analyzed. In the second model, all the risk factors found to be significant in univariate analysis were included. The value of p<0.05as there are significant differences; p<0.01had significant difference.Results:Mean BW and gestational age (GA) of the whole cohort were1448.16±304.66g and30.91±2.26weeks, respectively. Relative weight gain at1week,2weeks and3weeks postnatal age were significantly lower in infants with ROP. Relative weight gain at4weeks was not different between groups. Infants with ROP gained(g/kg/day) in the first3weeks of life, compared with those no ROP significance lower. After adjusted for BW and GA in logistic regression poor relative weight gain in the first3weeks was found to be related to ROP. When all the other risk factors significant for ROP were included in the logistic regression poor weight gain was an independent risk factor.Conclusions:Poor postnatal weight gain in the first3weeks of life is the end result of several comorbidities rather than being an independent risk factor. Poor weight gain can be an additional predictor of ROP.Part Ⅲ Analysis of clinical features and prognosis of242cases of retinopathy of prematurity Objective:To evaluate the clinical features of retinopathy of prematurity and the long-term therapeutic effect.Methods:The clinical data, ROP stage, the therapy and long-term prognosis of242preterm infants with ROP were retrospectively analyzed, who were admitted to Children’s Hospital of Fudan University between January1,2002to December31,2011.Results:179preterm infants with Stage1or2ROP, Among54follow-up infants, include29infants with Stage1and25infants with Stage2.6infants with Stage2ROP developed to type I threshold ROP and received the laser therapy. All the follow-up infants except the death did not need special treatment without the vision affected later and the lesions of ROP were self-limiting.29infants were detected with Stage3ROP, Eleven follow-up infants had no blindness,but three vision was affected severely after the treatment and8infants had the normal vision. There were28Stage4and5ROP infants, but18infants were followed up completely. In follow-up infants, there was only one infant with the normal post-operative vision (5.56%),12ones had blindness after treatment (66.67%), and the remaining five ones had poor eyesight and were light-sensitive (27.78%). There were2infants with APROP,1case of stage0ROP,1case with obsolete ROP,2cases of degenerative ROP. Among242cases of ROP,182cases without treatment,23cases were simple laser treatment,4cases were simple condensate treatment,19cases underwent vitrectomy treatment,6cases underwent scleral resection,5patients undergoing laser combined with vitrectomy,1patients underwent laser combined with scleral resection,2patients received cryotherapy combined with vitrectomy excision.Conclusions:It’s a key step to screening and intervention in time at the early stage of ROP. Otherwise the outcome is very poor when developed to the late stage with retinal detachment.