Abstract
Purpose With advancement in neonatal care units, early detection of retinopathy of prematurity (ROP) in premature and very-low-birth-weight infants is important. Numerous studies have reported an increased risk of ROP in prematurely born infants, but only few have been long-term and strictly population-based. The aim of the present study was to find out whether birthweight <1251 grams and gestational age <30 weeks could provide a safe and efficient means of detecting treatable ROP. We have retrospectively tried to ascertain the incidence and associated risk factors that may contribute to the management of babies with ROP.
Methods Infants either with a birth weight below 1500 g or a gestational age of less than 32 weeks were screened for ROP during an 8-year period by a single examiner.Results An incidence of 64/205 (31.2%) ROP was noted. The mean age at detection was 5.5 ± 2 weeks of life. The maximum stage reached was stage 1 in 27 (13.2%), stage 2 in 24 (11.7%) and stage 3 in 10 (4.8%) babies. Threshold ROP was present in three (1.5%) babies. Significantly fewer (150/205 = 73%) babies would have been examined had a birth weight of <1251 grams and a gestational age <30 weeks been applied. there were five (8%) babies with birth weight >1250 grams and eight (12%) babies with gestational age >30 weeks amongst babies with ROP but all were stage 1 or stage 2. All the stage 3 ROP and the threshold ROP cases were babies with birth weight <1000 grams and gestational age below 28 weeks.
Conclusion Ophthalmic examination may be safely and efficiently concentrated in babies with birth weight <1251 grams and gestational age below 30 weeks. Birth weight (P < 0.005) and gestational age (P < 0.01) were the only significant risk factors. During this 8-year period there was no significant decrease in the number of babies screened for ROP and the overall incidence of all stages of the disease has remained constant. In the present series a lower incidence of severe ROP was noted compared to most previous studies. Our experience from this study suggests the need for further refinement of screening guidelines in order to focus screening on the vision-threatening stages of ROP.
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References
Schalij-Delfos NE, Zizlmans BL, Wittebol-Post D et al. Screening for retinopathy of prematurity: do former guidelines apply?. J Paediatr Ophthalmol Strabismus 1996; 33: 35–38
Schalij-Delfos NE, Cats BP . Retinopathy of prematurity: the continuing threat to vision in preterm infants. Dutch survey from 1986 to 1994. Acta Ophthalmol Scand 1997; 75: 72–75
Fledelius HC . Retinopathy of prematurity in Frederiksborg County 1988–1990. A prospective investigation, an update. Acta Ophthalmol Suppl 1993; 210: 59–62
Holmstrom G, el Azazi M, Lennerstrand G . A population based, prospective study of the development of ROP in prematurely born children in the Stockholm area of Sweden. Br J Ophthalmol 1993; 77: 417–423
Palmer EA, Flynn JT, Hardy RJ, Phelps DL et al. Incidence and early course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Co-operative Group. Ophthalmology 1991; 98: 1628–1640
Fleck BW, Wright E, Dhillon B, Millar GT, Laing IA . An audit of the 1995 Royal College of Ophthalmologists guidelines for screening for retinopathy of prematurity applied retrospectively in one regional neonatal intensive care unit. Eye 1995; 9: 31–35
Fledelius HC . Retinopathy of prematurity in Denmark. Epidemiological considerations and screening limits. Eur J Ophthalmol 1996; 6: 183–186
Gezer A, Sezen F, Serifoglu I, Karacorlu M . Management of retinopathy of prematurity with cryotherapy. Eur J Ophthalmol 1999; 40: 1305–1309
Haugen OH, Markestad T . Incidence of retinopathy of prematurity (ROP) in the Western part of Norway. A population-based retrospective study. Acta Ophthalmol Scand 1997; 75: 305–307
Nodgaard H, Andreasen H, Hansen H, Sorenson HT . Risk factors associated with retinopathy of prematurity (ROP) in northern Jutland, Denmark 1990–1993. Acta Ophthalmol Scand 1996; 74: 306–310
Bianchi PE, Salati R, Guagliano R et al. Review of experience with retinopathy of prematurity from Pavia registry (1990–1993). Eur J Ophthalmol 1996; 6: 187–191
Royal College of Ophthalmologists and British Association of perinatal medicine. Retinopathy of Prematurity: Guidelines for Screening and Treatment The report of a joint working party 1995
An international classification of retinopathy of prematurity. Arch Ophthalmol 1984; 102: 1130–1134
Cryotherapy for cooperative group multicenter trial of cryotherapy for retinopathy of prematurity: one-year outcome, structure and function. Arch Ophthalmol 1990; 108: 1408–1416
Slevin M, Murphy JF, Daly L, O’Keefe M . Retinopathy of prematurity screening, stress related responses, the role of nesting. Br J Ophthalmol 1997; 81: 762–764
Lee SK, Normand C, McMillan D et al. Evidence for changing guidelines for routine screening for retinopathy of prematurity. Arch Pediatr Adolesc Med 2001; 155: 387–395
Schalij-Delfos NE, Zijllmans BL, Cats BP . Towards a universal approach for screening of retinopathy of prematurity (ROP). Doc Ophthalmol 1996–97; 92: 137–144
Javitt J, Dei Cas R, Chiang YP . Cost-effectiveness of screening and cryotherapy for threshold retinopathy of prematurity. Pediatrics 1993; 91: 859–866
Ng YK, Fielder AR, Shaw DE, Levene MI . Epidemiology of retinopathy of prematurity. Lancet 1988; ii: 1235–1238
Bagdoniene R, Surtautiene R . Threshold retinopathy of prematurity in Lithuania. In: Reibaldi A, Di Pietro M, Scuderi A, Malerba E (eds). Progress in Retinopathy of Prematurity Kugler Publications: Amsterdam/New York 1997 31–36
Cottrell DG, Inglesby DV, Pollock W . Comments. Eye 1998; 12: 1035
Lim J, Fong DS, Dang Y . Decreased prevalence of retinopathy of prematurity in an inner-city hospital. Ophthalmic Surgery and Lasers 1999; 30: 12–16
Goble RR, Jones HS, Fielder AR . Are we screening too many babies for retinopathy of prematurity?. Eye 1997; 11: 509–514
Fledelius HC, Dahl H . Retinopathy of prematurity decrease in frequency and severity prevalence trends over 16 years in a Danish county. Acta Ophthalmol Scand 2000; 78: 359–361
Deshpande DA, Chaturvedi M, Gopal L, Ramachandran S, Shanmugasundaram MP . Treatment of threshold retinopathy of prematurity. Ind J Ophthalmol 1998; 46: 15–19
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Mathew, M., Fern, A. & Hill, R. Retinopathy of prematurity: are we screening too many babies?. Eye 16, 538–542 (2002). https://doi.org/10.1038/sj.eye.6700031
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