Fatores de risco para retinopatia da prematuridade: uma revisão sistemática

Cestari, Yasmim Laila Fragoso; Lima, Maria Adriely Cunha; Rezende, Mateus Lenier; Fonseca, Larissa Marrocos

doi:10.37039/1982.8551.20210052

Brasil

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Review Article • Rev. bras.oftalmol. 80 (6) • 2021 • https://doi.org/10.37039/1982.8551.20210052 linkcopiar

Fatores de risco para retinopatia da prematuridade: uma revisão sistemática

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

O objetivo deste estudo foi descrever a prevalência dos fatores de risco associados à retinopatia da prematuridade e aos seus estágios. Para isso, foi realizado uma busca nas bases de dados SciELO, VHL e PubMed^® de estudos originais que analisavam os fatores de risco para retinopatia da prematuridade foram encontrados. Inicialmente, encontrou-se 186 artigos. Após a leitura dos títulos e dos resumos e de acordo com os critérios de inclusão e de exclusão, foram escolhidos 25 artigos para compor a base de dados deste estudo. Observa-se que houve uma grande diversidade nas variáveis dos estudos. Em relação aos fatores de risco, todos os artigos mencionaram idade gestacional e peso. Ao analisar o sexo, houve uma pequena discrepância, cerca de 52,9% eram do sexo masculino e 47,1% do feminino. Em relação à raça/cor, aproximadamente 72,7% eram brancos, 12% pardos e 2,7% pretos. No entanto, não há consenso sobre esses aspectos na literatura. O estudo constatou que a retinopatia da prematuridade é uma doença multifatorial, tendo como principais fatores de risco prematuridade, baixo peso ao nascer e oxigenoterapia. Trata-se de uma doença de alta incidência, apesar de ser evitável e reversível, portanto, pesquisas como esta são essenciais para conhecer os fatores associados e, assim, reduzir as consequências a longo prazo da doença.

Descritores: Retinopatia da prematuridade; Fatores de risco; Recém-nascido; Oxigenoterapia; Morbidade

	Category 1^* * Articles included in the study;	Category 2^† † articles excluded from the study
Category Kappa	0.8173	0.8173
Standard error of category Kappa	0.0645	0.0636
95% confidence interval for category Kappa	Upper: 0.9438	Upper: 0.9417
95% confidence interval for category Kappa	Lower: 0.6908	Lower: 0.6929

Author	Sample size (n)	Type of study
Souza(¹¹)	50	Prospective descriptive and analytical longitudinal clinical trial for individualized intervention
Rover et al.(¹⁵)	71	Retrospective study
Portes et al.(¹⁶)	151	Observational cohort study
Schumann et al.(¹⁷)	73	Retrospective cross-sectional study
Shinsato et al.(¹⁸)	70	Prospective study
Tomé et al.(¹⁹)	148	Retrospective cross-sectional observational study
Almeida et al.(²⁰)	33	Retrospective cohort study
Vieira et al.(²¹)	267	Retrospective study
Fortes Filho et al.(²²)	157	Prospective cohort study
Gonçalves et al.(²³)	110	Longitudinal study
Jorge et al.(²⁴)	232	Prospective cohort study
Moinho et al.(²⁵)	343	Observational case-control study
Silva et al.(²⁶)	172	Retrospective, analytical, case-control study
Theis et al.(²⁷)	320	Cross-sectional and retrospective study
Freitas(²⁸)	602	Retrospective cohort study
Horewicz et al.(²⁹)	183	Quantitative research approach with descriptive cross-sectional design
Martins(³⁰)	280	Observational epidemiological study with case control design
Pereira et al.(³¹)	296	Retrospective cross-sectional study
Fonseca et al.(³²)	323	Cohort study
Lamy-Filho.(³³)	1.961	Retrospective cohort study
Malheiro et al.(³⁴)	375	Retrospective study
Okamoto et al.(³⁵)	58	Cohort study
Pastro et al.(³⁶)	181	Retrospective cohort study
Xavier et al.(³⁷)	119	Cross-sectional, retrospective study
Cagliari et al.(³⁸)	322	Retrospective study

Author	Gender (male/female)	Gestational age (weeks)	Birth weight (gram)	Gestation	Mode of delivery	Apgar Score
Souza(¹¹)	23/27	<30: 14 30-32: 24 >32: 11 Average: 30.9	<1,000: 12 1,000-1,500: 35 >1,500: 3	Twin: 4 Single: 46	–	–
Rover et al.(¹⁵)	36/35	Average: 29.4	VLBW AGA: 50 NBs	–	Vaginal: 29 Cesarean: 42	–
Portes et al.(¹⁶)	–	Average: 26.62	Average: 1,109	–	–	1st minute average: 5.5
Schumann et al.(¹⁷)	33/40	Average: 30.5	Average: 1,153 SGA: 36	Prenatal care: 61 Intercurrence: 47	Vaginal: 23 Cesarean: 50 Intercurrence: 28	5th minute average: 8
Shinsato et al.(¹⁸)	–	Average: 28.155	Average: 1,030.935	–	–	1st minute average: 5.2
Tomé et al.(¹⁹)	–	<28: 8 28-32: 65 31-34: 56 35-36: 17 >36: 3	≤1,000: 27 1,000-1,500: 115 >1,500: 6	–	–	1st minute ≤3: 20 5th minute ≤7: 27
Almeida et al.(²⁰)	–	Average: 30.51	Average: 1,182.35	–	–	–
Vieira et al.(²¹)	135/132	Average: 29	Average: 1,193	Twin: 72 Single: 195	Vaginal: 69 Cesarean: 198	–
Fortes Filho et al.(²²)	65/92	Average: 28.3	Average: 844,04	–	Twin: 22	–
Gonçalves et al.(²³)	54/56	≤ 32	≤1,500	Prenatal care: 81 Intercurrence: 79	Vaginal: 72 Cesarean: 38	<7 1st minute: 73 5th minute: 26
Jorge et al.(²⁴)	118/114	Average: 29.4	Average: 1,219.4	Twin: 39 Single:193	–	–
Moinho et al.(²⁵)	186/157	Average: 29.5	Average: 1,173	Twin: 93 Single: 250 Complicated: 215	–	–
Silva et al.(²⁶)	98/74	Average: 29.4	Average: 1,171.9	–	–	1st minute average: 5
Theis et al.(²⁷)	–	<32: 194 32-37: 115 >37: 11	<1,000: 54 1,000-2,500: 251 >2,500: 15	Twin: 49 Single: 271	–	–
Freitas(²⁸)	302 /300	Average: 29.4	<1,000: 148	Twin: 108 Single: 494	–	1st minute average: 6
Horewicz et al.(²⁹)	93/ 90	27-31: 66 32-35: 98 >36: 19	<970: 19 987-1,950: 140 >1,950: 23	–	–	–
Martins(³⁰)	132/141	≤27: 55 >27: 224	≤1,000: 88 1,000-1,500: 188	–	–	–
Pereira et al.(³¹)	152/144	Average: 32.08	Average: 1,662.54	Prenatal care: 273	Vaginal: 93 Cesarean: 103	<7 1st minute: 107 5th minute: 30
Fonseca et al.(³²)	55/45	Average: 28.6	Average: 1,041	Prenatal care: 89	Vaginal: 37 Cesarean: 63	<7 5th minute: 29
Lamy-Filho.(³³)	–	≤35	≤2,000	–	–	–
Malheiro et al.(³⁴)	–	Average: 29.3	Average: 1,158.7	–	–	–
Okamoto et al.(³⁵)	26/32	30	Average: 1,061.8	–	–	–
Pastro et al.(³⁶)	–	<37	<2,000	–	–	–
Xavier et al.(³⁷)	54/65	23-25: 8 26-29: 19 30-32: 4 >32: 0	<1,000: 22 1,000-1,499: 6 1,500-2,500: 3 >2,500: 0	–	Vaginal: 73 Cesarean: 46	–
Cagliari et al.(³⁸)	173/ 149	Average: 29.5	Average: 1,181.8	–	–	–

Risk fator	Scientific evidence	Lack of scientific evidence	Variable
Gestational age	All	–	Smaller
Birth weight	All	–	Smaller
Oxygen exposure time	Portes et al.(¹⁶) Schumann et al.(¹⁷) Shinsato et al.(¹⁸) Souza(¹¹) Tomé et al.(¹⁹) Almeida et al.(²⁰) Vieira et al.(²¹) Moinho et al.(²⁵) Silva et al.(²⁶) Theis et al.(²⁷) Horewicz et al.(²⁹) Martins(³⁰) Okamoto et al.(³⁵) Pastro et al.(³⁶) Xavier et al.(³⁷) Lamy-Filho.(³³) Cagliari et al.(³⁸) Fortes Filho et al.(²²)^* * risk factors for severe retinopathy of prematurity.	–	Longer duration (days)
Type of oxygen exposure	Shinsato et al.(¹⁸) Tomé et al.(¹⁹) Moinho et al.(²⁵) Lamy-Filho.(³³) Pastro et al.(³⁶) Cagliari et al.(³⁸) Fortes Filho et al.(²²)^* * risk factors for severe retinopathy of prematurity.	Portes et al.(¹⁶) Martins(³⁰)	Mechanical ventilation CPAP Others
Apgar 1st minute	Portes et al.(¹⁶) Pereira et al.(³¹) Silva et al.(²⁶) Gonçalves et al.(²³)	–	Changed
Apgar 5th minute	Schumann et al.(¹⁷) Moinho et al.(²⁵) Silva et al.(²⁶) Lamy-Filho.(³³) Gonçalves et al.(²³)	Portes et al.(¹⁶) Souza(¹¹) Pereira et al.(³¹)	Changed
Sepsis	Moinho et al.(²⁵) Theis et al.(²⁷) Martins(³⁰) Xavier et al.(³⁷) Fonseca et al.(³²) Gonçalves et al.(²³)	Portes et al.(¹⁶) Shinsato et al.(¹⁸) Souza(¹¹)	Presence
Comorbidity/respiratory syndromes	Vieira et al.(²¹) Moinho et al.(²⁵) Theis et al.(²⁷) Freitas(²⁸) Lamy-Filho.(³³) Xavier et al.(³⁷) Gonçalves et al.(²³)	Portes et al.(¹⁶) Shinsato et al.(¹⁸) Martins(³⁰) Silva et al.(²⁶)	Presence
Cardiovascular comorbidity	–	Portes et al.(¹⁶)	Presence
Digestive comorbidity	–	Silva et al.(²⁶) Freitas(²⁸)	Presence
Hemodynamic impairment	Vieira et al.(²¹)	–	Presence
Use of surfactant	Vieira et al.(²¹) Moinho et al.(²⁵) Silva et al.(²⁶) Lamy-Filho.(³³) Gonçalves et al.(²³)	Portes et al.(¹⁶) Martins(³⁰) Xavier et al.(³⁷)	Higher dose and longer use
Use of aminophylline or caffeine	Gonçalves et al.(²³)	–	–
Use of indomethacin	Moinho et al.(²⁵)	Portes et al.(¹⁶) Martins(³⁰)	Higher dose and longer use
Use of erythropoietin	Vieira et al.(²¹)	–	Higher dose and longer use
Use of diuretic	Shinsato et al.(¹⁸) Gonçalves et al.(²³)	Martins(³⁰)	Higher dose and longer use
Blood type and RH factor	–	Portes et al.(¹⁶)	–
Neonatal infections	Theis et al.(²⁷)	Portes et al.(¹⁶) Okamoto et al.(³⁵)	Presence
Intraventricular hemorrhage	Vieira et al.(²¹) Theis et al.(²⁷) Freitas(²⁸)	Souza(¹¹)	Presence
Intracranial hemorrhage	–	Shinsato et al.(¹⁸) Moinho et al.(²⁵) Silva et al.(²⁶) Martins(³⁰)	Presence Moinho et al.(²⁵)
Intracranial hypertension	Tomé et al.(¹⁹)	–	Presence
Phototherapy	Martins(³⁰)	–	Longer use
Blood transfusions	Schumann et al.(¹⁷) Shinsato et al.(¹⁸) Tomé et al.(¹⁹) Vieira et al.(²¹) Theis et al.(²⁷) Martins(³⁰) Lamy-Filho.(³³) Pastro et al.(³⁶) Xavier et al.(³⁷) Cagliari et al.(³⁸) Gonçalves et al.(²³)	Souza(¹¹) Okamoto et al.(³⁵)	Larger number
Gender	–	Souza(¹¹) Moinho et al.(²⁵) Theis et al.(²⁷) Freitas(²⁸) Martins(³⁰)	–
Mode of delivery	–	Vieira et al.(²¹) Freitas(²⁸)	–
Hypoglycemia	–	Okamoto et al.(³⁵)	–
Jaundice	Xavier et al.(³⁷)	Silva et al.(²⁶) Okamoto et al.(³⁵)	–
Gestational complications	–	Moinho et al.(²⁵) Okamoto et al.(³⁵)	Presence
Twin pregnancy	Jorge et al.(²⁴)	Souza(¹¹) Moinho et al.(²⁵) Theis et al.(²⁷)	–
Patent ductus arteriosus	Tomé et al.(¹⁹) Moinho et al.(²⁵) Theis et al.(²⁷) Xavier et al.(³⁷) Fonseca et al.(³²)	Martins(³⁰)	Presence

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[TFN1] ^*
Articles included in the study;

[TFN1a] ^†
articles excluded from the study