出生時體重過低的嬰兒發生斜視的風險高出許多


  【24drs.com】根據線上發表於7月21日JAMA Pediatrics期刊的研究,出生時體重不到2000 g的早產兒,斜視風險達14倍,且與妊娠年齡(GA)無關。
  
  密西根大學視力科學暨眼科W.K. Kellogg眼科中心醫學系四年級學生Shilpa Gulati等人,計算了38,055名健康狀況一般之早產兒的斜視風險,這些嬰兒年齡介於新生到出生後6個月內。
  
  有慢性疾病的孩童則不納入研究,妊娠年齡32週以下被定義為極早產,妊娠年齡介於33-36週被定義為輕微早產;出生體重過低則是定義為體重低於2000 g;有出生體重和妊娠年齡資料的25,601名早產兒中,6571名(25.7%)嬰兒屬於出生體重過低、19,030人(74.3%)屬於輕微低體重。
  
  早產嬰兒中,21,956人(85.8%)屬於輕微早產,3,645人(14.2%)屬於極早產;極早產的嬰兒中,2,980人(81.8%)也屬於出生體重過低;輕微低體重的19,030名嬰兒中,96.5%屬於輕微早產;到了5歲時,3.0% (583人)嬰兒被診斷有斜視。
  
  研究者校正了妊娠年齡、性別、種族、居住於都會區或鄉村、家庭收入淨額、分娩方式、早產兒視網膜病變(ROP)、以及其他眼科狀況;出生體重過低嬰兒發生斜視的風險增加61%(校正風險比[AHR]為1.61;95%信心區間[CI]為1.22 - 2.13),出生體重在2500 g以下,每減少250 g則斜視風險增加13% (AHR,1.13;95% CI,1.04 - 1.23)。
  
  校正體重和其他共變項之後,研究者發現斜視和妊娠年齡之間沒有顯著關聯(HR,0.98;95% CI,0.69 - 1.38);在出生體重過低的嬰兒中,妊娠年齡32週以下的斜視風險並未顯著高於32週以上之嬰兒(HR,1.27;95% CI,0.86 - 1.88)。反之,妊娠年齡32週以下的嬰兒中,出生體重過低者的斜視風險是出生體重大於2000 g者的14倍(HR,14.39;95%,1.99 - 104.14)。
  
  研究結果認為,對於出生體重過低的嬰兒,兒科體檢時應增加定期檢查斜視和弱視。
  
  作者們寫道,2012年美國眼科學院小兒眼科評估最佳實務模式提出孩童檢查斜視或其他眼科狀況之頻率的指引。這些或其他指引都不是由美國兒科學院提出,都建議除了出生後10週內檢查早產兒視網膜病變之外,還須仔細監測低體重早產兒的斜視和弱視。根據這次和其他分析結果,後續指引應考慮建議對低體重早產兒在出生後一年內定期檢查斜視。
  
  6個月至5歲孩童有2%至4%患有斜視,若未治療,斜視會增加弱視風險。作者們寫道,此外,它會影響孩子的自我形象和社交。早期研究認為,及早介入可以達到最佳視力,減少其他手術介入的需要。
  
  早產兒斜視增加的原因一直是一個有爭議的問題,體重和妊娠年齡都有被研究發現屬於獨立風險因素。兩篇研究只有提到妊娠年齡,另一篇研究認為體重和妊娠年齡都會增加風險。探討早產兒斜視的其他研究,發現斜視和妊娠年齡或體重都無關;不過,這些研究只有探討嚴重早產的嬰兒。
  
  其他斜視風險因素包括屈光參差與屈光不正、遺傳、父母年紀較大、母親在懷孕期間抽菸、神經發育不良、Apgar分數低、顱面畸形和染色體異常、在子宮內暴露於某些毒素、早產兒視網膜病變以及剖腹產。
  
  資料來源: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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