Cerebral injury and retinopathy as risk factors for blindness in extremely preterm infants.

IF 3.9 2区 医学 Q1 PEDIATRICS
Benjamin M Honan, Scott A McDonald, Colm P Travers, Vivek V Shukla, Namasivayam Ambalavanan, C Michael Cotten, Viral G Jain, Hope E Arnold, Nehal A Parikh, Jon E Tyson, Susan R Hintz, Stephen A Walker, Marie G Gantz, Abhik Das, Waldemar A Carlo
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Abstract

Objective: This study investigates whether and to what extent cerebral injury is associated with bilateral blindness in extremely preterm infants, which has been attributed mainly to retinopathy of prematurity (ROP).

Design: Multicentre analysis of children born from 1994 to 2021 at gestational age 22 0/7 to 28 6/7 weeks with follow-up at 18-26 months. Logistic regression examined the adjusted association of bilateral blindness with severe ROP and/or cerebral injury among extremely preterm infants.

Exposures: Severe ROP and cerebral injury, the latter defined as any of the following on cranial imaging: ventriculomegaly; blood/increased echogenicity in the parenchyma; cystic periventricular leukomalacia.

Main outcome measures: Bilateral blindness, defined as a follow-up examination meeting criteria of 'blind-some functional vision' or 'blind-no useful vision' in both eyes.

Results: The 19 863 children included had a mean gestational age of 25.6±1.7 weeks, mean birth weight of 782±158 g and 213 (1%) had bilateral blindness. Multiplicative interaction between ROP and cerebral injury was statistically significant. For infants with only severe ROP (n=3130), odds of blindness were 8.14 times higher (95% CI 4.52 to 14.65), and for those with only cerebral injury (n=2836), odds were 8.38 times higher (95% CI 5.28 to 13.28), compared with the reference group without either condition. Risks were not synergistic for infants with both severe ROP and cerebral injury (n=1438, adjusted OR=28.7, 95% CI 16.0 to 51.7, p<0.0001).

Conclusions: In a group of extremely preterm infants, severe ROP and cerebral injury were equally important risk factors for blindness. Besides ROP, clinicians should consider cerebral injury as a cause of blindness in children born extremely preterm.

Trial registration number: NCT00063063.

脑损伤和视网膜病变是极早产儿失明的危险因素。
目的:本研究探讨脑损伤是否以及在多大程度上与极早产儿双侧失明有关:本研究探讨脑损伤是否以及在多大程度上与极早产儿双侧失明有关,而双侧失明主要归因于早产儿视网膜病变(ROP):设计:对 1994 年至 2021 年出生、胎龄 22 0/7 周至 28 6/7 周、随访 18-26 个月的婴儿进行多中心分析。逻辑回归检验了极早产儿双侧失明与严重早产儿视网膜病变和/或脑损伤的调整关联:暴露:严重早产儿视网膜病变和脑损伤,后者定义为头颅成像中出现以下任何一种情况:脑室肿大;实质内充血/回声增强;囊性室周白斑:双侧失明,即随访检查双眼均符合 "失明-部分功能性视力 "或 "失明-无有用视力 "的标准:纳入的 19 863 名儿童的平均胎龄为 25.6±1.7 周,平均出生体重为 782±158 克,其中 213 人(1%)双目失明。视网膜病变与脑损伤之间的相互影响具有统计学意义。与无任何一种情况的参照组相比,仅患重度视网膜病变的婴儿(3130 人)失明几率是参照组的 8.14 倍(95% CI 4.52 至 14.65),仅患脑损伤的婴儿(2836 人)失明几率是参照组的 8.38 倍(95% CI 5.28 至 13.28)。同时患有严重早产儿视网膜病变和脑损伤的婴儿的风险并不协同(样本数=1438,调整后OR=28.7,95% CI 16.0至51.7,p结论:在一组极早产儿中,严重的视网膜病变和脑损伤同样是导致失明的重要风险因素。除了早产儿视网膜病变,临床医生还应考虑脑损伤也是导致极早产儿失明的原因之一:NCT00063063.
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来源期刊
CiteScore
9.00
自引率
4.50%
发文量
90
审稿时长
6-12 weeks
期刊介绍: Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.
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