目的：评价地塞米松疗法对早产儿视网膜病变(retinopathy of prematurity，ROP)的发生率和严重程度的影响。ROP是导致婴幼儿视力损害的重要原因之一，甚至导致失明。近年来，由于新生儿护理技术的提高，能够存活的(极)低出生体重儿不断增加，导致发生ROP高危人群的产生。产前和产后类固醇(postnatal steroids，PNS)的使用对ROP发生率的影响尚有争议，并且该制剂与ROP严重程度的相关性尚未评估。

方法：选取儿童医院2012-04/2013-06出生体重不足1500克并胎龄不足29周的115例新生儿进行双盲对照研究。随机分为病例组和对照组，病例组内给予8～14d的新生儿静脉滴注地塞米松，对照组不予注射。从出生后6wk开始进行眼科检查并持续至病症消退。

结果：收入新生儿重症监护室、出生体重不足1500克的新生儿的存活率为69%(80/115)。新生儿胎龄越低(≤25周和26～28周)ROP发生率越高。参加此项研究的58例婴幼儿中，ROP(二期或二期以上)的发生率为8.6%。在接受PNS的28例新生儿中，2例(7.4%)发生严重的早产儿视网膜病变。而在没有接受PNS的30例新生儿中，有3例(9.7%)确诊为ROP。接受PNS婴幼儿与对照组婴幼儿ROP的发生率无显著差异(P=0.35)。此外，病例组(7.4%)和对照组(9.7%)比较，严重ROP(二期以上)发生率也无显著差异(P=0.36)。

结论：此研究表明，接受地塞米松静脉滴注的新生儿与未接受地塞米松滴注的新生儿在早产儿视网膜病变的发生率和严重程度上无显著差异。因此，注射地塞米松治疗早产儿慢性肺病通常不会增加ROP发生的危险性。

AIM: To evaluate the impact of postnatal dexamethasone therapy(PNS)on incidence and severity of retinopathy of prematurity(ROP)in premature infants. ROP is one of the most important causes of visual impairment in infants which can lead to blindness. The increased survival of extremely low birth weight and low birth weight(LBW)infants in recent years due to advances in neonatal care has produced a population of infants at very high risk of developing ROP. Not only there are controversies around the effect of antenatal and postnatal steroids(PNS)on the incidence of ROP in premature infants, the association of this agent and severity of ROP has not yet been assessed.

METHODS: A total of 115 neonates with birth weight less than 1500g and gestational age less than 29wk were selected from Children Hospital between April 2012 and June 2013 who met the criteria for entering this double blind control study. Patients were divided randomly into case and control groups and intravenous dexamethasone 0.25mg/kg/12h was administered from day 8 to day 14 of age for case group and the control group received no dexamethasone. Ophthalmologic examinations were started at 6^th week and followed until resolution.

RESULTS: Of the neonates with ≤1500g birth weight admitted to neonatal intensive care unit, 69%(80/115)survived. Neonates of lower gestational age(≤25wk and 26-28wk)had an increased incidence of ROP. The incidence of ROP(stage II or higher)was 8.6% among all 58 infants enrolling this study. Severe retinopathy of prematurity was detected in 2(7.4%)of 28 neonates received PNS and 3(9.7%)of 30 neonates who did not received PNS. No significant difference was observed for ROP incidence between postnatal dexamethasone receiving versus control group infants(P=0.35). Beyond that the incidence of severe ROP(stage>II)did not have significant difference between cases(7.4%)and control(9.7%)group too(P=0.36).

CONCLUSION: Our study demonstrated that there is no marked difference between neonates received post natal dexamethasone and no receiving neonates on incidence and severity of retinopathy of prematurity. Therefore, dexamethasone which was useful in treatment of chronic lung disease in preterm infants seems be safely administered without concern about increasing risk of ROP.