Der frühe postnatale Gewichtsverlauf als Prädiktor einer Frühgeborenenretinopathie

 

 Buy Article Permissions and Reprints

Zusammenfassung

Hintergrund: Das aktuelle Screening auf eine Frühgeborenenretinopathie (ROP) stellt für die häufig noch instabilen Säuglinge eine hohe Belastung dar und ist bei einer Therapiewahrscheinlichkeit von weniger als 10 % ineffizient. Zudem berücksichtigen die aktuellen Leitlinien keine frühen postnatalen Faktoren. Eine Methode, welche postnatale Faktoren in das Screening mit einbezieht, ist der weight, insulin-like growth factor, neonatal ROP (WINROP) Algorithmus. Dieser basiert auf dem frühen postnatalen Gewichtsverlauf. Das Ziel dieser Studie war es, den WINROP-Algorithmus auf eine Frühgeborenenpopulation in der Schweiz zu übertragen und bezüglich seiner Vorhersagekraft zu analysieren. Patienten und Methoden: Retrospektiv wurden alle Frühgeborene mit einem Gestationsalter < 32 SSW und/oder einem Geburtsgewicht ≤ 1500 g, welche von Januar 2003 bis Dezember 2008 in der Klinik für Neonatologie des UniversitätsSpitals Zürich betreut wurden, eingeschlossen. Der wöchentliche postnatale Gewichtsverlauf wurde mithilfe des modifizierten WINROP-Algorithmus analysiert. Ergebnisse: Insgesamt wurden 376 Frühgeborene analysiert. Bei 58 dieser Säuglinge wurde ein „High-risk”-Alarm ausgelöst, davon entwickelten 8 Frühgeborene eine schwere ROP und 4 davon bedurften einer Lasertherapie. Die Sensitivität des modifizierten WINROP-Algorithmus lag bezüglich der Vorhersage einer schweren ROP bei 90 %, die Spezifität bei 63 %. Schlussfolgerungen: Der WINROP-Algorithmus zeigte in der hier untersuchten Schweizer Frühgeborenenpopulation eine hohe Vorhersagekraft. Dieses Instrument hat das Potenzial, die bisherigen Screening-Richtlinien zu vereinfachen. Damit könnte eine Vielzahl der bislang durchgeführten Ophthalmoskopien vermieden werden.

Abstract

Background: Premature infants are often stressed by the current retinopathy of prematurity (ROP) screening procedure. Additionally, only < 10 % of the screened infants will develop a ROP stadium requiring laser therapy. Therefore the present screening strategy is unsatisfactory. Furthermore, the current guidelines do not take into account postnatal factors. A new method considering postnatal factors is the weight, insulin-like growth factor, neonatal ROP (WINROP) algorithm. This approach is based on the early postnatal weight gain. The aim of this study was to assign the WINROP-algorithm to a preterm population in Switzerland and to analyze its ability for prediction. Patients and Methods: In this retrospective study, all preterm infants with a gestational age (GA) < 32 weeks and/or a birth weight (BW) ≤ 1500 g taken care of in the Department of Neonatology at the University Hospital Zurich from January 2003 to December 2008 were included. The weekly postnatal weight gain was analyzed by means of the modified WINROP-algorithm. Results: Altogether 376 preterm infants were analyzed. In 58 infants a ”high-risk” alarm was released, thereof eight preterms developed a severe ROP and four of them needed laser therapy. Conclusions: The high predictive value of the WINROP-algorithm was confirmed in our population of Swiss preterms. This instrument has the potential to simplify the current ROP screening procedure. Accordingly, the amount of ophthalmoscopies could be reduced significantly.

Literatur

• 1 Jandeck C et al. Frühgeborenenretinopathie-Screening: Ergebnisse eines Zentrums zwischen 1991 und 2002.  Klin Monatsbl Augenheilkd. 2005;  222 577-585
  Google Scholar
• 2 Larsson E, Carle-Petrelius B, Cernerud G et al. Incidence of ROP in two consecutive Swedish population based studies.  Br J Ophthalmol. 2002;  86 1122-1126
  Google Scholar
• 3 Cryotherapy for Retinopathy of Prematurity Cooperative Group . Multicenter trial of cryotherapy for retinopathy of prematurity. Three- month outcome.  Arch Ophthalmol. 1990;  108 195-204
  Google Scholar
• 4 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 1684-1694
  Google Scholar
• 5 Lad E, Nguyen T, Morton J et al. Retinopathy of prematurity in the United States.  Br J Ophthalmol. 2008;  92 320-332
  Google Scholar
• 6 Brennan R, Gnanaraj L, Cottrell D G. Retinopathy of prematurity in practice. I: screening for threshold disease.  Eye. 2003;  17 183-188
  Google Scholar
• 7 Gilbert C, Fielder A, Gordillo L et al. 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 e518-e525
  Google Scholar
• 8 McLoone E M, O’Keefe M, McLoone S F et al. Long-term refractive and biometric outcomes following diode laser therapy for retinopathy of prematurity.  J AAPOS. 2006;  10 454-459
  Google Scholar
• 9 Laws D E, Morton C, Weindling M et al. Systemic effects of screening for retinopathy of prematurity.  Br J Ophthalmol. 1996;  80 425-428
  Google Scholar
• 10 Kleberg A, Warren I, Norman E et al. Lower stress responses after Newborn Individualized Developmental Care and Assessment Program care during eye screening examinations for retinopathy of prematurity: a randomized study.  Pediatrics. 2008;  121 e1267-e1278
  Google Scholar
• 11 Slidsborg C, Olesen H B, Jensen P K et al. Treatment for retinopathy of prematurity in Denmark in a ten-year period (19962 005): is the incidence increasing?.  Pediatrics. 2008;  121 97-105
  Google Scholar
• 12 Gilbert C. Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control.  Early Hum Dev. 2008;  84 77-82
  Google Scholar
• 13 Löfqvist C, Andersson E, Sigurdsson J et al. Longitudinal postnatal weight and insulin-like growth factor I measurements in the prediction of retinopathy of prematurity.  ArchOphthalmol. 2006;  124 1711-1718
  Google Scholar
• 14 Löfqvist C, Hansen-Pupp I, Andersson E et al. Validation of a new retinopathy of prematurity screening method monitoring longitudinal postnatal weight and insulinlike growth factor I.  Arch Ophthalmol. 2009;  127 622-627
  Google Scholar
• 15 Hellström A, Hard A L, Engström E et al. Early weight gain predicts retinopathy in preterm infants: new, simple, efficient approach to screening.  Pediatrics. 2009;  123 e638-e645
  Google Scholar
• 16 The Committee for the Classification of Retinopathy of Prematurity . An international classification of retinopathy of prematurity.  Arch Ophthalmol. 1984;  102 1130-1134
  Google Scholar
• 17 The International Committee for the Classification of Retinopathy of Prematurity . An international classification of retinopathy of prematurity revisited.  Arch Ophthalmol. 2005;  123 991-999
  Google Scholar
• 18 Allegaert K, Vanhole C, Casteels I et al. Perinatal growth characteristics and associated risk of developing threshold retinopathy of prematurity.  J AAPOS. 2003;  7 34-37
  Google Scholar
• 19 Early Treatment for Retinopathy of Prematurity Cooperative Group . The early treatment for retinopathy of prematurity study: structural findings at age 2 years.  Br J Ophthalmol. 2006;  90 1378-1382
  Google Scholar
• 20 Bardin C, Zelkowitz P, Papageorgiou A. Outcome of small-for-gestational age and appropriate-for-gestational age infants born before 27 weeks of gestation.  Pediatrics. 1997;  100 1-5
  Google Scholar
• 21 Filho J B, Bonomo P P, Maia M et al. Weight gain measured at 6 weeks after birth as a predictor for severe retinopathy of prematurity: study with 317 very low birth weight preterm babies.  Graefes Arch Clin Exp Ophthalmol. 2009;  247 831-836
  Google Scholar
• 22 Lineham J D, Smith R M, Dahlenburg G W et al. Circulating insulin-like growth factor I levels in newborn premature and full-term infants followed longitudinally.  Early Hum Dev. 1986;  13 37-46
  Google Scholar
• 23 Hellström A, Carlsson B, Niklasson A et al. IGF-I is critical for normal vascularization of the human retina.  J Clin Endocrinol Metab. 2002;  87 3413-3416
  Google Scholar
• 24 Hellström 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 5804-5808
  Google Scholar
• 25 Hellström A, Engström E, Hard A L et al. Postnatal serum insulin-like growth factor I deficiency is associated with retinopathy of prematurity and other complications of premature birth.  Pediatrics. 2003;  112 1016-1020
  Google Scholar
• 26 Wu C, VanderVeen D K, Hellström A. Longitudinal postnatal weight measurements for the prediction of retinopathy of prematurity.  Arch Ophthalmol. 2010;  128 443-447
  Google Scholar
• 27 Haines L, Fielder A R, Scrivener R et al. Retinopathy of prematurity in the UK: the organization of services for screening and treatment.  Eye. 2002;  16 33-38
  Google Scholar
• 28 Hård A L, Löfqvist C, Filho J B et al. Predicting proliferative retinopathy in a Brazilian population of preterm infants with the screening algorithm WINROP.  Arch Ophthalmol. 2010;  128 1432-1436
  Google Scholar
• 29 Arlettaz R, Mieth D, Bucher H U et al. End-of-life decisions in delivery room and neonatal intensive care unit.  Acta Paediatr. 2005;  94 1626-1631
  Google Scholar

Sarah Flückiger

Klinik für Neonatologie, UniversitätsSpital Zürich

Frauenklinikstraße 10

8091 Zürich

Schweiz

Phone: ++ 41/44/2 55 53 40

Fax: ++ 41/44/2 55 44 42

Email: sarah_flk@hotmail.com