Kein Anstieg von Inzidenz, Therapie- und Erblindungsrate der Retinopathia praematurorum in einem universitären Perinatalzentrum Level 1 – eine prospektive Beobachtungsstudie von 1978 – 2007

 

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Zusammenfassung

Hintergrund: Es besteht Uneinigkeit darüber, ob die gestiegene Überlebensrate von extrem untergewichtigen und extrem unreifen Kindern zur Erhöhung der Inzidenz der Retinopathia praematurorum (ROP) und dadurch bedingte Erblindungen geführt hat. Wir untersuchen Inzidenz, Behandlung und den anatomischen Ausgang der ROP über einen 30 Jahreszeitraum in einem perinatologischen Perinatalzentrum Level 1. Patienten und Methode: Von 1978 – 2007 wurden 1473 überlebende Kinder mit einem Geburtsgewicht (GG) unter 1500 g (VLBW) prospektiv erfasst und augenärztlich untersucht. Eine Koagulationsbehandlung wurde bei proliferativer ROP, „threshold disease” und „Typ-1-ROP” in Anlehnung an die „CRYO-ROP”- und „ETROP”-Studie durchgeführt. Ausgewertet wurden die Unterschiede im Patientengut zwischen dem ersten (P1) und zweiten 15-Jahreszeitraum (P2) und den Kindern mit einem Geburtsgewicht < 1000 g und > 1000 g. Ergebnisse: In P 1 überlebten 43,1 % (n = 87) der Kinder mit dem GG < 1000 g (ELBW) in P 2 82,3 % (n = 372), von den Kinder mit dem GG 1000 – 1499 g 74,6 % (n = 453) bzw. 95,1 % (n = 561). Eine ROP hatten in P 1 27,6 % (n = 149) dagegen nur 15,1 % (n = 141) in P 2 (p < 0,003), obwohl das mittlere GG 1136,6 ± 211,3 g und Gestationsalter (GA) 29,3 ± 2,2 Wochen (W) auf das mittlere GG 822,3 ± 215,3 g bzw. GA 26,4 ± 2,0 W signifikant sank (p < 0,001). Die Rate koagulierter Kinder sank von 13,0 % (n = 70) in P 1 auf 6,8 % (n = 63) in P 2 signifikant (p = 0,043). Der Rückgang der Erblindungsrate (Stadium 4b oder 5 beidseits) von 1,5 % in P 1 auf 1,0 % in P 2 war nicht signifikant (p = 0,543). Die Anzahl retinopathiekranker ELBW-Kinder erhöhte sich von 39 in P 1 auf 117 in P 2, während die ROP-Inzidenz von 44,8 % auf 31,5 % (p = 0,053) und die OP-Häufigkeit von 19,5 % auf 14,8 % (p < 0,029) fiel. Die Zahl der retinopathiekranken Kinder mit einem GA < 28 W stieg von 66 in P 1 auf 121 in P 2, aber die ROP-Inzidenz ging von 70,2 auf 27,6 % und ihre OP-Notwendigkeit von 30,9 auf 13,2 % zurück (jeweils p < 0,001). Schlussfolgerungen: Im Beobachtungszeitraum von 1978 – 2007 kommt es in der ROP-Risikopopulation der sehr untergewichtigen/sehr unreifen Neugeborenen (VLBW) trotz Anstiegs der Zahl und Überlebensrate extrem unreifer/extrem untergewichtiger Kinder (ELBW) nicht zum Anstieg der ROP-Inzidenz, ihrer Behandlungsbedürftigkeit und Erblindungsrate.

Abstract

Background: There is a controversy over whether the improved survival rate of extremely low birth weight (ELBW; birth weight < 1000 g) and of extremely low gestational age (ELGA; gestational age < 28 weeks) infants has resulted in a higher incidence of severe retinopathy of prematurity (ROP) and induced blindness. We studied the incidence, treatment and the structural outcome of ROP in a Perinatal Centre Level III over a 30-year period in infants < 1500 g birth weight (VLBW = very low birth weight). Patients and Methods: 1473 VLBW infants, who survived the first 28 days, had ocular examinations from 1978 to 2007. Neonatal and ROP data were collected prospectively. Proliferative ROP, threshold disease and high-risk prethreshold ROP indicated treatment for peripheral retinal ablation in respect to the CRYO-ROP and ETROP studies. Incidence, treatment and structural outcome of ROP were analysed for the periods 1978 – 1992 (P1) and 1993 – 2007 (P2) and for children with BW < 1000 g and > 1000 g. Results: In P 1 43.1 % (n = 87) ELBW infants survived and 82.3 % (n = 372) in P 2, whereas the survival rates of the infants with a BW of 1000 – 1499 g were 74.6 % (n = 453) and 95.1 % (561), respectively. The ROP incidence was decreased from 27.6 % (n = 149) in P 1 to 15.1 % (n = 141) in P 2 significantly (p < 0.003) as well the mean BW 1136.6 ± 211.3 g to a mean BW 822.3 ± 215.3 g and the mean gestational age (GA) 29.3 ± 2.2 weeks and to a mean GA 26.4 ± 2 weeks, respectively (both differences p < 0.001). Also the coagulation rate was significantly decreased from 13 % (n = 70) in P 1 to 6.8 % (n = 63) in P 2 (p = 0.043). The blindness rates (structurally unfavourable outcome of both eyes) of 1.5 % in P 1 and 1.0 % in P 2 were not significantly reduced (p = 0.543). Among the ELBW the number of ROP infants was increased from 39 in P 1 to 117 in P 2 while the ROP incidence decreased from 44.8 % to 31.5 % (p = 0.053) and the ROP-OP rate from 19.5 % to 14.8 % (p = 0.029). Also among the ELGA the number ROP infants was increased from 66 in P 1 to 121 in P 2 but the ROP incidence was reduced from 70.2 % to 27.6 % and the ROP-OP rate from 30.9 % to 13.2 % (both p < 0.001). Conclusions: Inspite of an increase of the number of ELBW/ELGA infants and their survival rate in 1978 – 2007 there is no increase in the incidence of ROP, operations and blindness among the VLBW and VLGA infants.

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