出生时体重过低的婴儿发生斜视的风险高出许多


  【24drs.com】根据在线发表于7月21日JAMA Pediatrics期刊的研究,出生时体重不到2000 g的早产儿,斜视风险达14倍,且与妊娠年龄(GA)无关。
  
  密西根大学视力科学暨眼科W.K. Kellogg眼科中心医学系四年级学生Shilpa Gulati等人,计算了38,055名健康状况一般之早产儿的斜视风险,这些婴儿年龄介于新生到出生后6个月内。
  
  有慢性疾病的孩童则不纳入研究,妊娠年龄32周以下被定义为极早产,妊娠年龄介于33-36周被定义为轻微早产;出生体重过低则是定义为体重低于2000 g;有出生体重和妊娠年龄资料的25,601名早产儿中,6571名(25.7%)婴儿属于出生体重过低、19,030人(74.3%)属于轻微低体重。
  
  早产婴儿中,21,956人(85.8%)属于轻微早产,3,645人(14.2%)属于极早产;极早产的婴儿中,2,980人(81.8%)也属于出生体重过低;轻微低体重的19,030名婴儿中,96.5%属于轻微早产;到了5岁时,3.0% (583人)婴儿被诊断有斜视。
  
  研究者校正了妊娠年龄、性别、种族、居住于都会区或乡村、家庭收入净额、分娩方式、早产儿视网膜病变(ROP)、以及其它眼科状况;出生体重过低婴儿发生斜视的风险增加61%(校正风险比[AHR]为1.61;95%信心区间[CI]为1.22 - 2.13),出生体重在2500 g以下,每减少250 g则斜视风险增加13% (AHR,1.13;95% CI,1.04 - 1.23)。
  
  校正体重和其它共变项之后,研究者发现斜视和妊娠年龄之间没有显著关联(HR,0.98;95% CI,0.69 - 1.38);在出生体重过低的婴儿中,妊娠年龄32周以下的斜视风险并未显著高于32周以上之婴儿(HR,1.27;95% CI,0.86 - 1.88)。反之,妊娠年龄32周以下的婴儿中,出生体重过低者的斜视风险是出生体重大于2000 g者的14倍(HR,14.39;95%,1.99 - 104.14)。
  
  研究结果认为,对于出生体重过低的婴儿,儿科体检时应增加定期检查斜视和弱视。
  
  作者们写道,2012年美国眼科学院小儿眼科评估最佳实务模式提出孩童检查斜视或其它眼科状况之频率的指引。这些或其它指引都不是由美国儿科学院提出,都建议除了出生后10周内检查早产儿视网膜病变之外,还须仔细监测低体重早产儿的斜视和弱视。根据这次和其它分析结果,后续指引应考虑建议对低体重早产儿在出生后一年内定期检查斜视。
  
  6个月至5岁孩童有2%至4%患有斜视,若未治疗,斜视会增加弱视风险。作者们写道,此外,它会影响孩子的自我形象和社交。早期研究认为,及早介入可以达到最佳视力,减少其它手术介入的需要。
  
  早产儿斜视增加的原因一直是一个有争议的问题,体重和妊娠年龄都有被研究发现属于独立风险因素。两篇研究只有提到妊娠年龄,另一篇研究认为体重和妊娠年龄都会增加风险。探讨早产儿斜视的其它研究,发现斜视和妊娠年龄或体重都无关;不过,这些研究只有探讨严重早产的婴儿。
  
  其它斜视风险因素包括屈光参差与屈光不正、遗传、父母年纪较大、母亲在怀孕期间抽菸、神经发育不良、Apgar分数低、颅面畸形和染色体异常、在子宫内暴露于某些毒素、早产儿视网膜病变以及剖腹产。
  
  资料来源:http://www.24drs.com/professional/list/content.asp?x_idno=7101&x_classno=0&x_chkdelpoint=Y
  

Strabismus Risk Much Higher in Very Low Birth Weight Infants

By Jenni Laidman
Medscape Medical News

The risk for strabismus was 14 times higher in very premature infants who weighed less than 2000 g at birth, independent of gestational age (GA), according to a study published online July 21 in JAMA Pediatrics.

Shilpa Gulati, MS, fourth-year medical student, W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, and colleagues calculated strabismus risk among 38,055 otherwise healthy premature infants who were enrolled from birth to at least age 6 months in a managed care plan.

The researchers excluded chronically ill children from the study. Infants with a GA of 32 weeks or less were defined as very premature, and those with a GA of between 33 and 36 weeks were identified as mildly premature. Very low birth weight (BW) was defined as a weight of less than 2000 g. Of 25,601 premature infants for whom BW and gestational age were known, 6571 (25.7%) of the infants were considered very low BW and 19,030 (74.3%) were mildly low BW.

Of the premature infants, 21,956 (85.8%) were mildly premature and 3645 (14.2%) were very premature. Among very premature infants, 2980 (81.8%) were also very low BW. Among 19,030 infants with mildly low BW, 96.5% were mildly premature. By age 5 years, 3.0% (583) of the infants were diagnosed with strabismus.

The researchers adjusted for GA, sex, race, urban/rural residence, household net worth, delivery method, retinopathy of prematurity (ROP), and other ocular conditions. Infants with very low BW were at a 61% increased hazard of developing strabismus (adjusted hazard ratio [AHR], 1.61; 95% confidence interval [CI], 1.22 - 2.13). The risk for strabismus increased by 13% for every 250 g below a BW of 2500 g (AHR, 1.13; 95% CI, 1.04 - 1.23).

After adjusting for BW and other covariates, the researchers found no significant association between strabismus and GA (HR, 0.98; 95% CI, 0.69 - 1.38). In very low BW infants, a GA of 32 weeks or fewer conveyed no significant risk for strabismus compared with the risk of infants born later than 32 weeks (HR, 1.27; 95% CI, 0.86 - 1.88) Conversely, among infants with a GA of 32 weeks or fewer, very low BW was associated with a 14-fold increase in risk compared with infants who weighed more than 2000 g (HR, 14.39; 95%, 1.99 - 104.14).

The results suggest a potential need for increased routine pediatric eye examinations for strabismus and amblyopia in very low BW infants.

"The 2012 American Academy of Ophthalmology Preferred Practice Pattern for Pediatric Eye Evaluations offers guidelines on how frequently children should undergo ocular examinations to check for strabismus and other ocular diseases," the authors write. "Neither these guidelines nor guidelines put forth by the American Academy of Pediatrics recommend that clinicians carefully monitor premature infants of low BW for strabismus and amblyopia beyond the standard monitoring in the first 10 weeks of life to check for ROP. Based on the findings of our analysis and the analyses of others, future guidelines may consider recommending that premature infants with low BW undergo periodic assessment in the first few years of life to check for strabismus."

Strabismus affects 2% to 4% of children aged 6 months to 5 years. When untreated, strabismus increases the risk for amblyopia. Further, it can affect a child's self-image and social interactions. Early intervention achieved the best visual acuity in earlier studies, reducing the need for additional surgical intervention, the authors write.

The cause of increased strabismus in premature infants has been a subject of debate, with studies finding both BW and GA to be independent risk factors. Two studies pointed to GA only, and another study suggested that both BW and GA increased risk. Other studies looking at strabismus in premature infants found no association between strabismus and either GA or BW; however, the studies looked at only infants who were severely premature.

Other strabismus risk factors include anisometropia and refractive error, genetics, older parental age, maternal smoking during pregnancy, neurodevelopmental impairment, low Apgar scores, craniofacial abnormalities and chromosomal abnormalities, in utero toxin exposure, ROP, and cesarean delivery.

This study was supported by the W.K. Kellogg Foundation and a National Eye Institute K23 Mentored Clinician Scientist Award and a Research to Prevent Blindness Physician Scientist Award to one coauthor, and a Lew R. Wasserman Merit Award to another coauthor. The authors disclosed no other relevant financial relationships.

JAMA Pediatrics. Published online July 21, 2014.

    
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