Der frühe postnatale Gewichtsverlauf als Prädiktor einer Frühgeborenenretinopathie

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.

Schlüsselwörter

Frühgeborenenretinopathie - ROP-Screening - Weight, insulin-like growth factor, neonatal ROP Algorithmus - WINROP-Algorithmus - Gewichtsverlauf

Key words

retinopathy of prematurity - ROP-screening - weight, insulin-like growth factor, neonatal ROP algorithm - WINROP-algorithm - weight gain

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