Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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The outcomes of retinopathy of prematurity in relation to duration of low dose oxygen therapy

저농도 산소의 사용기간에 따른 미숙아 망막병증의 진행과 예후에 관한 연구

  • 이필상 (대구파티마병원 소아청소년과) ;
  • 최재원 (대구파티마병원 소아청소년과) ;
  • 이상길 (대구파티마병원 소아청소년과)
  • Received : 2008.04.24
  • Accepted : 2008.11.07
  • Published : 2009.01.15
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Abstract

Purpose : This study aimed to determine the influence of low-dose oxygen ($FiO_2$ <25%) therapy through nasal cannulae on the progress and prognosis of retinopathy of prematurity (ROP) as well as methods of preventing ROP. Methods : Our subjects comprised premature infants (gestation period <37 weeks; birth weight <1,750 g) born in Daegu Fatima Hospital between February 1, 2001 and January 31, 2006. We retrospectively reviewed and analyzed the medical records of 273 patients who were available for eye examination and follow up over 6 months. Results : The factors maximally influencing the occurrence of ROP were low gestation age and low birth weight. We observed that the incidence of ROP increased with the increasing duration of low-dose oxygen therapy. ROP onset was delayed during ongoing oxygen therapy; however, rapid progression of ROP occurred after the discontinuation of oxygen therapy among premature infants up to the prethreshold stage. Conclusion : To prevent of occurrence of severe ROP and its rapid progression, the period of low-dose oxygen therapy needs to be shortened. Moreover, frequent eye examinations should be performed after the discontinuation of oxygen therapy.

목 적 : 최근 신생아 집중치료의 발전으로 미숙아의 생존율이 증가하면서 미숙아 망막병증도 증가하는 추세이다. 재태 연령 및 출생체중과 미숙한 망막이 중요한 위험인자이지만, 이 외에 무호흡, 패혈증, 인공호흡기의 사용, 장기간의 산소사용 역시 유의한 위험 인자로 알려져 있다. 이에 본 연구는 만성 폐질환 환아에서 nasal cannula를 통한 저농도 산소($FiO_2$ 25% 미만)의 사용 기간이 미숙아 망막병증의 진행에 미치는 영향을 알아보고, 미숙아 망막병증의 예방 및 진행의 완화에 도움을 주고자 본 연구를 시행하였다. 방 법 : 2001년 2월 1일부터 2006년 1월 31일까지 본원 출생아중 재태 연령 37주 미만이면서 출생체중 1,750 g 미만의 생존한 미숙아들로, 안저 검사를 받고 최소 6개월 이상 추적관찰이 가능했던 273명의 미숙아를 대상으로 의무기록을 기초로 후향적 분석을 통해 미숙아 망막병증의 발생에 영향을 미치는 여러 위험인자들을 검토하고, 저농도 산소의 사용 기간이 미숙아 망막병증의 발생과 임상경과 및 예후에 미치는 영향을 조사하였다. 만성 폐질환은 생후 28일 혹은 재태주령 36주가 되는 시점에 산소 의존도가 있었던 경우로 정의하였다. 결과 : 미숙아 망막병증의 발생에 가장 큰 영향을 미치는 인자로는 짧은 재태연령과 적은 출생체중이었고, 기타 무호흡, 표면활성제의 사용, 인공호흡기, 신생아 호흡곤란 증후군, 뇌실내 출혈 등의 순으로 상대적 위험도가 높았다. 저농도 산소 사용 기간이 길어질수록 미숙아 망막병증의 발생률은 높아지고, 미숙아 망막병증의 발병 시기는 지연되는 경향을 보였다. 수술적 치료를 받은 환아들에서 일단 미숙아 망막병증이 발병한 후에는 수술적 치료가 필요한 정도의 심각한 미숙아 망막병증으로 진행하는 기간 간격은 짧아지는 경향을 보였으며, 특히 만성 폐질환 환아군에서 산소를 투여하고 있는 기간 중보다는 산소를 중단한 이후에 미숙아 망막병증이 급격하게 진행되는 경향을 보였다. 결론 : 심각한 미숙아 망막병증의 발병 및 급속한 진행을 예방하기 위하여 가능한 한 저농도 산소라도 사용기간을 줄이고, 산소 사용 중단 이후에는 좀 더 적극적인 추적 안저 검사를 해야 할 것으로 생각된다.

Keywords

References

  1. Wagner RS. Increased incidence and severity of retinopathy of prematurity in developing nations. J Pediatr Ophthalmol Strabismus 2003;40:208-12
  2. Gibson DL, Sheps SB, Schechter MT, Wiggins S, McCormic AQ. Retinopathy of prematurity: a new epidemic? Pediatrics 1989;83:486-92
  3. Terry TL. Extreme prematurity and fibroblastic overgrowth of persistent vascular sheath behind each crystalline lens. I. Priliminary reports. Am J Opthalmol 1942;25:203-4
  4. Seiberth V, Linderkamp O. Risk factors in retinopathy of prematurity. a multivariate statistical analysis. Ophthalmologica 2000;214:131-5 https://doi.org/10.1159/000027482
  5. Patz A, Eastham A, Higginbotham DH, Kleh T. Oxygen studies in retrolental fibroplasia II. The production of the microscopic changes of retrolental fibroplasia in experimental animals. Am J Ophthalmol 1953;36:1511-22
  6. Kinsey VE. Etiology of retrolental fibroplasia: preliminary report of a cooperative study of retrolental fibroplasia. Am J Ophthalmol 1955;40:166-74
  7. Silverman WA. A cautionary tale about supplemental oxygen: the albatross of neonatal medicine. Pediatrics 2004;113:394-6 https://doi.org/10.1542/peds.113.2.394
  8. The International Committee for the classification of the Late Stages of Retinopathy of Prematurity. An international classification of retinopathy of prematurity. II. The classification of retinal detachment. Arch Ophthalmol 1987;105:906-12
  9. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Multicenter trial of cryotherapy for retinopathy of prematurity. Snellen acuity and structural outcome at 5½ years after randomization. Arch Ophthalmol 1996;114:417-24
  10. Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Respir Crit Care Med 2001;163:1723-9
  11. Ehrenkranz RA, Walsh MC, Vohr BR, Jobe AH, Wright LL, Fanaroff AA, et al. National Institutes of Child Health and Human Development Neonatal Research Network. Validation of the National Institutes of Health consensus definition of bronchopulmonary dysplasia. Pediatrics 2005;116:1353-60 https://doi.org/10.1542/peds.2005-0249
  12. Roth AM. Retinal vascular development in premature infants. Am J Ophthalmol 1977;84:636-40
  13. Smith LE. IGF-1 and retinopathy of prematurity in the preterm infant. Biol Neonate 2005;88:237-44 https://doi.org/10.1159/000087587
  14. Hussain N, Clive J, Bhandari V. Current incidence of retinopathy of prematurity, 1989-1997. Pediatrics 1999;104:e26 https://doi.org/10.1542/peds.104.3.e26
  15. Maheshwari R, Kumar H, Paul VK, Singh M, Deorari AK, Tiwari HK. Incidence and risk factors of retinopathy of prematurity in a tertiary care newborn unit in New Delhi. Natl Med J India 1996;9:211-4
  16. Cho YU, Koo BS. Incidence and Risk Factors in Retinopathy of Prematurity. J Korean Ophthamol Soc 1993;34:851-9
  17. Good WV, Hardy RJ, Dobson V, Palmer EA, Phelps DL, Quintos M, et al. Early Treatment of Retinopathy of Prematurity Cooperative Group. The incidence and course of retinopathy of prematurity: findings from the early treatment for retinopathy of prematurity study. Pediatrics 2005;116:15- 23 https://doi.org/10.1542/peds.2004-1413
  18. Palmer EA, Flynn JT, Hardy RJ, Phelps DL, Phillips CL, Schaffer DB, et al. Incidence and early course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology 1991;98:1628-40
  19. Repka MX, Hudak ML, Parsa CF, Tielsch JM. Calf lung surfactant extract prophylaxis and retinopathy of prematurity. Ophthalmology 1992;99:531-6
  20. Kim TI, Sohn JH, Yoon YH, Kim KS, Pi SY. Postnatal risk factors of retinopathy of prematurity. J Korean Ophthalmol Soc 2000;41:1229-35
  21. Ahn BS, Oh SY. Risk factors of retinopathy of prematurity. J Korean Ophthalmol Soc 1999;40:757-64 https://doi.org/10.1159/000027482
  22. Shweiki D, Itin A, Soffer D, Keshet E. Vascular endothelial growth factor induced by hypoxia may mediate hypoxia- initiated angiogenesis. Nature 1992;359:843-5 https://doi.org/10.1038/359843a0
  23. Kinsey VE, Arnold HJ, Kalina RE, Stern L, Stahlman M, Driscoll JM Jr, et al. PaO2 level and retrolental fibroplasia. a report of the cooperative study. Pediatrics 1977;60:655-68
  24. Flynn JT, Bancalari E, Bawol R, Goldberg R, Cassady J, Schiffman J, et al. Retinopathy of prematurity. A randomized, prospective trial of transcutaneous oxygen monitoring. Ophthalmology 1987;94:630-8 https://doi.org/10.1016/S0161-6420(87)33400-1
  25. Pierce EA, Foley ED, Smith LE. Regulation of vascular endothelial growth factor by oxygen in a model of retinopathy of prematurity. Arch Ophthalmol 1996;114;1219-28
  26. Simons BD, Flynn JT. Retinopathy of prematurity and associated factors. Int Ophthalmol Clin 1999;39:29-48
  27. Lineham JD, Smith RM, Dahlenburg GW, King RA, Haslam RR, Stuart MC, 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 https://doi.org/10.1016/0378-3782(86)90096-4
  28. Hellstrom A, Perruzzi C, Ju M, Engstrom E, Hard AL, Liu JL, et al. Low IGF-1 suppresses VEGF survival signaling in retinal endothelial cells: direct correlation with clinical retinopathy of prematurity. Proc Natl Acad Sci USA 2001;98: 5804-8 https://doi.org/10.1073/pnas.101113998
  29. Adamkin DH, Shott RJ, Cook LN, Andrews BF. Nonhyperoxic retrorental fibroplasia. Pediatrics 1977;60:828-30
  30. Naiman J, Green WR, Patz A. Retrolental fibroplasia in hypoxic newborn. Am J Ophthalmol 1979;88:55-8

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