Retinopatija nedonoščadi – pojavnost, rizični čimbenici, liječenje i ishod

Petrinović-Dorešić, Jelena (2011) Retinopatija nedonoščadi – pojavnost, rizični čimbenici, liječenje i ishod. PhD thesis, Sveučilište u Zagrebu.

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Abstract

Objectives: (1) To determine the incidence of retinopathy of prematurity (ROP) in premature infants born and followed a tertiary hospital in Zagreb; (2) to study the influence of gestational age (GA) and birth weight (BW) on the incidence of ROP; (3) to assess the structural and functional outcome of ROP treatment; (4) to define the inclusion criteria for ROP screening.-----Patients and methods: Data of infants screened for ROP from December 2000 to February 2009 were retrospectively reviewed. The study included 221 infants born and followed in our hospital and 44 referred from other hospitals for further follow-up. GA, BW and eye examinations’ findings were recorded.-----Results: ROP incidence was 38 (17,2%) of the 221 infants from our hospital; 11 had severe ROP (5%). The mean gestational age and birth weight of patients with ROP were 28,9 ± 2,1 weeks and 1165,5 ± 267,6 g, respectively. There was a broad range for both parameters, for GA 24,4-34,6 weeks, and for BW 600 to 1880g. Five infants with ROP (6,1% of all children with ROP) had a gestational age greater than 32 g, one of them required therapy, and seven (8,5% of all children with ROP) had a birth weight greater than 1,500 g, six of them required therapy. GA was better predictor for ROP than BW. The chances for ROP development were about 40% less with every additional week of GA, and about 20% less with every 100g of birth weight. ROP was first noticed on average with 36,1 weeks of postmenstrual age (PMA) (range 32,3-39,0) and was more related to PMA than postnatal age. Severe ROP was detected in 10 children to late, in 7 in both and in 3 in one eye. The time between detection of stage requiring therapy and treatment was 7-8 days on average. In spite of timely detection of ROP in ten eyes due to delayed treatment (range 2-15 days) ROP progressed to stage 4. In the period of the study, neither the number of at risk children for developing ROP increased, nor the incidence of ROP decreased. There was no change in GA or BW either. Treatment was performed in most cases between 38,5-39 weeks of PMA. Unfavorable structural outcome with cryotherapy was 72,2%, and with diode laser 36,4%, and was worse in eyes with ROP in zone 1 (40% , i.e. 4/10 laser treated eyes). Unfavorable functional outcome was found in 76,5% of cryotherapy eyes, and in 60% of laser eyes. In 84% of eyes with ROP myopia developed, with median of spherical equivalent of -5,0 d and -4,25 d for right and left eyes, respectively.-----Conclusion: The incidence of ROP observed in this study is in accordance with that in developed countries, but relatively more mature infants were affected. Inclusion criteria for GA < or = 32,9 weeks and for BW < or = 1880 g would have identified all infants who developed ROP requiring therapy in our cohort of patients. The current inclusion criteria of BW < or = 1500g and/or GA < or = 32 weeks should be modified, or criteria of «unstable clinical course» (re)defined. The time period of 48-72 hours between detection of stage requiring therapy and treatment should be respected. The creation of national registry for low-birth weight children should be instituted in order to detect the impact of individual risk factors on development of ROP.

Abstract in Croatian

Ciljevi: (1) Odrediti pojavnost retinopatije nedonoščadi (ROP-a) u skupini djece rođene i praćene u tercijarnoj bolnici u Zagrebu; (2) istražiti utjecaj gestacijske dobi (GD) i porodne mase (PM) na pojavnost ROP-a; (3) ocijeniti strukturalni i funkcionalni ishod liječenja ROP-a; (4) odrediti kriterije za uključivanje u programe probira za ROP.-----Ispitanici i metode: Retrospektivno su analizirani podaci djece praćene zbog ROP-a u razdoblju od prosinca 2000. do veljače 2009. godine. Istraživanje je uključilo 221 dijete rođeno i praćeno u našoj bolnici, kao i 44 djece upućene iz drugih bolnica zbog daljnjeg praćenja. Bilježila se GD, PM i nalazi oftalmoloških pregleda.-----Rezultati: Pojavnost ROP-a je bila 38 (17,2%) od 221 djeteta iz naše bolnice; 11 je imalo teški ROP (5%). Srednja GD bolesnika s ROP-om je bila 28,9 ± 2,1 tjedana, a PM 1165,5 ± 267,6 g. Postojao je veliki raspon vrijednosti za oba obilježja; za GD 24,4-34,6 tjedana, a za PM 600 do 1880g. Petero djece s GD >32 tjedna (6,1% sve djece s ROP-om) je imalo ROP, od toga jedno dijete teški oblik, te sedmero djece s PM>1500g (8,5% sve djece s ROP-om), od toga šestero teški. Gestacijska dob je bila bolji prediktor ROP-a nego PM. Šanse za pojavu ROP-a su bile za oko 40% manje s svakim dodatnim tjednom gestacijske dobi, odnosno za oko 20% manje sa svakih dodatnih 100 grama porođajne mase. ROP se prosječno pojavljivao s 36,1 tjedan PMD, s rasponom od 32,3-39,0 tjedana i njegova pojava je bila više vezana uz postmenstruacijsku (PMD) nego uz postnatalnu dob djeteta. Kod desetoro djece je teški ROP dijagnosticiran prekasno, od toga u sedmero djece na oba oka, a u troje na jednom oku. Vremenski period od postavljanja indikacije do liječenja bio je u prosjeku 7-8 dana. Kod deset očiju je unatoč pravodobno prepoznatom ROP-u zbog odgađanja liječenja (u rasponu od 2-15 dana), bolest progredirala u 4 stupanj. U ispitivanom razdoblju nije se niti povećavala rizična skupina djece, niti se smanjila pojavnost ROP-a. Također, nisu se mijenjale niti PM i GD. Prosječna dob djeteta u trenu liječenja bila je 38,5-39 tjedana PMD. Nepovoljni strukturalni ishod očiju s krioterapijom bio je 72,2%, a s diodnim laserom 36,4% i ishod je bio lošiji u očiju s ROP-om u zoni 1 (40% , odn. 4/10 očiju liječenih laserom). Nepovoljan funkcionalni ishod bio je u u 76,5% nakon krioterapije i u 60% nakon lasera. 84% očiju s ROP-om je bilo kratkovidno, s medijanom sfernog ekvivalenta -5,0 d za desne oči i -4,25 d za lijeve.-----Zaključak: Pojavnost ROP-a u našem istraživanju je u skladu s onom iz razvijenih zemalja, ali zahvaćeno je više zrelije djece. Kriteriji GD od manje ili jednako 32,9 tjedana i PM od manje ili jednako 1880g bi u analiziranoj skupini djece obuhvatili svu djecu s ROP-om kojeg je trebalo liječiti. Trenutačno važeći inkluzijski kriteriji od PM < ili = 1500g i/ili GD < ili = 32 tjedna bi se trebali modificirati ili bi se kriteriji «nestabilnog kliničkog tijeka» morali (re)definirati. Vremenski period od 48-72 sata od otkrivanja stadija koji zahtijeva liječenje do liječenja se treba poštovati. Trebao bi se formirati nacionalni registar za nedonoščad male PM, kako bi se uočio ujecaj pojedinih čimbenika rizika na razvoj ROP-a.

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