[Evaluation of a prospective card for prematures: retro- and prospective evaluation of 2393 histories].

BACKGROUND

Is it really true, that prematures have an accelerated maturation, are very intelligent and--with or without ectopic macula--get as myopic as Annette von Droste-Hülshoff was? To find a time schedule in prevention or early detection of retinopathy of prematurity (ROP) and also to detect risk factors, we looked for critical phases in the development of premature babies in analogy to those found in the development of other mammals.

PATIENTS AND

METHODS

We examined the data of 294 children (1981-84) retrospectively and then prospectively those of 100 children from 1984 - 93 and of further 1999 babies since then. All findings were noted in the International Committee for Retinopathy of Prematures scheme (ICROP 1984). We elaborated a time table which shows in parallel the actual dated and the age of the baby in gestational months, duration of oxygen application, birth weight, safety index s of the ancient Körner-Bossi and known risk factors, recently the blood serum glucose levels. In this so-called prospective card we noted the time table of developing ROP in 31 children. Furthermore, we chose matched pairs for these ROP-babies out of the data of 1200 healthy babies and evaluated risk factors such as days of oxygen supply and blood glucose levels. Finally, we transformed our data into an excel data base and calculated the economic advantages of examinations by our method.

RESULTS

After an adaptation to recent data we showed the epidemiology, therapeutic attempts and a critical review of so-called risk factors. Risk babies had a Körner-Bossi index of less than 1.0; this corresponds to a birth weight of less than 1000 g, a gestational age of less than 29 weeks, and oxygen application for more than 3 days. During the last 15 years, age and weight of the prematures decreased steadily. The onset of ROP occurred always between the 35th and the 40th gestational week. In spontaneous regression, cicatricional stages mostly started in the 41st week.

CONCLUSION

In order to win time for the examinator and to avoid stress for the baby, the prospective card proved very useful. It was helpful also in medico-legal discussions. The prospective card made it evident that the babies pass critical maturation stages during all their development, before as well as after birth. In screening premature babies, this critical phase requires to be respected.