The SWEDROP, a quality register for ROP, has a national coverage (ie, participation) of 96%. Data from 2008 to 2009 show that it seems possible to reduce the upper limit for screening in Sweden by 1 week, including only infants with a GA of 30 weeks + 6 days or less. However, such a change should be combined with a strong recommendation to neonatologists to refer also severely ill and more "mature" infants.

Aims: To determine the incidence of neonatal morbidity in extremely preterm infants and to identify associated risk factors. Methods: Population based study of infants born before 27 gestational weeks and admitted for neonatal intensive care in Sweden during 2004-2007. Results: Of 638 admitted infants, 141 died. Among these, life support was withdrawn in 55 infants because of anticipation of poor long-term outcome. Of 497 surviving infants, 10% developed severe intraventricular haemorrhage (IVH), 5.7% cystic periventricular leucomalacia (cPVL), 41% septicaemia and 5.8% necrotising enterocolitis (NEC); 61% had patent ductus arteriosus (PDA) and 34% developed retinopathy of prematurity (ROP) stage ≥ 3. Eighty-five per cent needed mechanical ventilation and 25% developed severe bronchopulmonary dysplasia (BPD). Forty-seven per cent survived to one year of age without any severe IVH, cPVL, severe ROP, severe BPD or NEC. Tocolysis increased and prolonged mechanical ventilation decreased the chances of survival without these morbidities. Maternal smoking and higher gestational duration were associated with lower risk of severe ROP, whereas PDA and poor growth increased this risk. Conclusions: Half of the infants surviving extremely preterm birth suffered from severe neonatal morbidities. Studies on how to reduce these morbidities and on the long-term health of survivors are warranted. Background and aims: Autism spectrum disorders (ASDs) are disorders of neural development characterized by impaired social interaction and communication, and by restricted and repetitive behavior. Previous studies investigating neonatal factors and ASDs have produced inconsistent results. We performed confirmatory analyses concerning various neonatal complications and a later diagnosis with ASDs, and infantile autism, specifically. Methods: A Danish population based cohort study, including all children born in Denmark from 1994, through 2002, a total of 604,140 children. Diagnoses of neonatal complications were retrieved from the Danish National Hospital Register. Children diagnosed with ASDs were identified using the Danish Psychiatric Central Register. Data was analyzed using Cox proportional hazards regression. Results: A total of 4,145 children were diagnosed with ASDs, of which 1,493 had infantile autism. We found an increased risk of ASDs after exposure to a variety of neonatal complications; respiratory distress: adjusted hazard ratio (HR)=1.24 [95% confidence interval (CI): 1.02-1.51], intracranial bleeding, cerebral edema or seizures: HR=1.94 [95% CI: 1.12-3.36], neonatal hypoglycemia: HR=1.46

Background: The most severe form of rapidly progressing retinopathy of prematurity (ROP) is termed aggressive posterior ROP (APROP). APROP frequently causes severe visual impairment in affected preterm infants despite timely and appropriate laser treatment. Objectives: We investigated the postnatal characteristics associated with APROP development in a national Swedish cohort. Methods: This retrospective, 1:1 matched case-control study included all infants that developed APROP in zone 1 (n = 9) between 2008 and 2012. Control infants, matched for gestational age and birth weight, developed ROP no worse than stage 2 (n = 9). We retrieved data from medical records on infant birth characteristics, postnatal morbidities, and blood analyses from birth to the first ROP treatment. Infectious episodes included sepsis, C-reactive protein ≥10 mg/l, and other clinical signs of infection that required antibiotic treatment. A platelet count <100 × 10⁹/l was considered to be thrombocytopenia. Results: All APROP cases postnatally developed at least two infectious episodes, one in the first month and one around the time of ROP diagnosis. All APROP cases exhibited thrombocytopenia in the first month, and 6/9 exhibited thrombocytopenia around the time of ROP diagnosis. Compared to the controls, APROP cases more frequently developed necrotizing enterocolitis (8/9 vs. 1/9; p < 0.01) and sepsis (9/9 vs. 3/9; p < 0.01), and they had significantly lower median platelet counts (90 × 10⁹/l, range 4-459, vs. 158 × 10⁹/l, range 20-500; p < 0.001). Conclusion: Multiple infectious episodes and thrombocytopenia, particularly around the time of ROP diagnosis, were associated with APROP development.

Background/aimsDuring the last decade, improved neonatal care has resulted in increased survival of the most immature infants and improved health of more mature infants. We hypothesise that this has affected incidence and treatment of retinopathy of prematurity (ROP), enabling guidelines for screening to be modified.MethodsIn Sweden, all infants with gestational age (GA) at birth ≤30 weeks are screened for ROP. Results are registered in a web-based register, Swedish National ROP Register, with a coverage rate of 97%. Incidence of ROP and frequency of treatment, aspects on natural course of ROP and number of examinations, are calculated in relation to GA at birth in infants born during 2008–2017.ResultsOf 7249 infants, 31.9% (2310) had ROP and 6.1% (440) were treated. No infant with GA 30 weeks was treated. Incidence of ROP remained similar, but frequency of treatment increased (p=0.023). Over time, GA and birth weight were reduced in infants with ROP and with treated ROP. In the most immature infants, postmenstrual age was lower and postnatal age was higher when any ROP and stage 3 ROP were first detected (p<0.001). At treatment, postmenstrual but not postnatal age of the infant was associated with GA (p<0.001). During the 10-year period, 46 038 examinations were performed.ConclusionModification of Swedish guidelines is proposed, including only infants with a GA of <30 weeks and postponing the first examination with 1 week in infants with GA 26–29 weeks. This would spare many infants from stressful examinations and reduce eye examinations with at least 20%.

Aims: To prospectively analyse the present incidence of ROP (retinopathy of prematurity) in a well defined geographical area in Sweden, and to compare it with that from a decade earlier in exactly the same area. Methods: Infants born between 1 August 1998 and 31 July 2000 with a birth weight of 1500 g or less were studied. They were screened for ROP from 5 weeks of postnatal age until the retina was entirely vascularised. The incidence of ROP, with its various stages, was compared with that of a previous population based study in the same geographical area. Results: The incidence of ROP in the present study was 36.4% (mild (18.2%) and severe ROP (18.2%)), which was similar to that of the previous study. Gestational age at birth remained the most important risk factor for ROP. We found a change in the distribution of ROP. The probability of ROP, particularly severe ROP, was highest in the most immature infants while it was lower in the least immature ones. Conclusions: The incidence of ROP remained the same in two consecutive population based studies. The more "mature" infants developed ROP, particularly severe ROP, less often, while the most immature infants had ROP more often, particularly severe ROP.