宁波地区早产儿生后0~12个月屈光发育的研究

Evolution of refractive status in premature infants during the first year after birth in Ningbo

目的观察宁波地区早产儿生后0~12月龄屈光状态的发育以及矫正胎龄6、12个月时屈光状态的影响因素。方法选取2017年1月至2019年8月在宁波市妇女儿童医院出生的接受早产儿视网膜病变(ROP)筛查的早产儿153例。早产儿在生后矫正胎龄40周,1、3、6、12个月时接受检影验光,记录球镜度数和柱镜度数,计算等效球镜度数。比较不同时间点等效球镜度数的变化,并分析矫正胎龄6、12个月时等效球镜度数与出生孕龄、出生体重、有无吸氧史及有无ROP的关系。结果矫正胎龄40周时,等效球镜度数为3.00(2.00,4.00)D,之后屈光状态向远视方向发展,至矫正胎龄1个月时等效球镜度数为3.50(2.25,4.50)D,之后进行了正视化过程,至矫正胎龄12个月时,等效球镜度降为1.00(0.38,1.50)D。矫正胎龄6个月时,早产儿出生体重、出生孕龄、有无吸氧史及有无ROP与等效球镜度数均无关(均P>0.05)。矫正胎龄12个月时,早产儿出生体重及有无ROP与等效球镜度数均有关(均P<0.05),而早产儿出生孕龄及有无吸氧史与等效球镜度数均无关(均P>0.05)。结论吸氧史、出生孕龄对早产儿早期屈光状态影响不大,而在随访至12个月时低出生体重及合并ROP的早产儿在早期即存在近视倾向。

Objective To analyze the evolution of the refractive status in premature infants during the first year after birth in Ningbo and its influencing factors.Methods One hundred and fifty three premature infants receiving retinopathy of prematurity(ROP)screening in Ningbo Women and Children's Hospital from January 2017 to August 2019 were enrolled in the study.The infants underwent examination of full cycloplegic retinoscopy at 40 weeks,1 month,3 months,6 months,and 12 months of postmenstrual age,the power of the spherical lens and the cylincler were recorded,and spherical equivalentat different time points was compared.The basic information was recorded including gestational age,birth weight,oxygen intake history,and the presence or absence of ROP.The relationship between spherical equivalent and postmenstrual age was analyzed,and the correlation between spherical equivalent at 6 and 12 months of postmenstrual age and the basic information was also analyzed.Results At 40 weeks of postmenstrual age,the spherical equivalent(SE)was 3.00(2.00,4.00)D,and then the SE had a hyperopic shift.At 1 month of postmenstrual age,the SE was 3.50(2.25,4.50)D.Then the mean SE declined.At 1 year of postmenstrual age,the SE was 1.00(0.38,1.50)D.At 6 and 12 months of postmenstrual age,there were no statistically significant difference in SE between oxygen and without oxygen group,low gestational age and high gestational age group(all P>0.05).The difference of SE between the ROP-free group and the combined ROP group and between low birth weight and high birth weight group were not statistically significant at 6 months of postmenstrual age(both P>0.05),while the difference were statistically significant at 12 months of postmenstrual age(both P<0.05).Conclusion Oxygen intake history and gestational age have little effect on the early refractive state of preterm infants,however low birth weight and preterm infants with ROP were prone to myopia at 12 months of postmenstrual age.