Five years of treatment for retinopathy of prematurity in Sweden: results from SWEDROP, a national quality register

Holmström, Gerd; Hellström, Ann; Jakobsson, Peter; Lundgren, Pia; Törnqvist, Kristina; Wallin, Agneta

doi:10.1136/bjophthalmol-2015-307263

Cited by 29 publications

(22 citation statements)

References 16 publications

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“…Exploring care practices associated with better outcomes should benefit future generations of extremely preterm infants. To understand differences in outcomes, networks should adopt common definitions to describe pathology and improve consistency in interpretation, minimise the amount of missing data and perhaps record an expanded dataset; specifically, for ROP, this should include information on plus disease and aggressive posterior-ROP 32. Perhaps the most important outcomes for families of extremely preterm infants beyond survival are long-term visual outcomes.…”

Section: Discussionmentioning

confidence: 99%

International variations and trends in the treatment for retinopathy of prematurity

et al. 2017

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Objective To compare the rates of retinopathy of prematurity (ROP) and treatment of ROP by laser or intravitreal anti-vascular endothelial growth factor among preterm neonates from high-income countries participating in the International Network for Evaluating Outcomes (iNeo) of neonates. Methods A retrospective cohort study was conducted on extremely preterm infants weighing <1500 g at 24 0 to 27 6 weeks' gestation who were admitted to neonatal units in Australia/New Zealand, Canada, Finland, Israel, Japan, Spain, Sweden, Switzerland, Tuscany (Italy) and the UK between 2007 and 2013. Pairwise comparisons of ROP treatment in survivors between countries were evaluated by Poisson and multivariable logistic regression analyses after adjustment for confounders. A composite outcome of death or ROP treatment was compared between countries using logistic regression and standardised ratios. Results Of 48 087 infants included in the analysis, 81.8% survived to 32 weeks postmenstrual age, and 95% of survivors were screened for ROP. Rates of any ROP ranged from 25.2% to 91.0% in Switzerland and Japan, respectively, among those examined. The overall rate of those receiving treatment was 24.9%, which varied from 4.3% to 30.4%. Adjusted risk ratios for ROP treatment were lower for Switzerland in all pairwise comparisons, whereas Japan displayed significantly higher ratios. Comparisons of the composite outcome between countries revealed similar, but less marked differences. Conclusions Rates of any ROP and ROP treatment varied significantly between iNeo members, while an overall decline in ROP treatment was observed during the study period. It is unclear whether these variations represent differences in care practices, diagnosis and/or treatment thresholds.

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Section: Discussionmentioning

confidence: 99%

International variations and trends in the treatment for retinopathy of prematurity

et al. 2017

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“…All infants were examined according to established Swedish ROP screening guidelines, previously described by Holmström et al [7]. APROP was diagnosed according the International Classification [6], which described it as follows: “The characteristic features of this type of ROP are its posterior location, prominence of plus disease, and the ill-defined nature of the retinopathy”.…”

Section: Methodsmentioning

confidence: 99%

“…APROP is a rare disease; in Sweden (2008 to 2012), 5.2 % of infants screened for ROP received treatment and of those treated, 4.9% had APROP in zone 1 [7]. APROP is characterized by its posterior location (most commonly observed in zone 1, close to the optic nerve, or in posterior zone 2), prominent vascular activity (neovascularizations and plus disease; i.e., vessel dilation and tortuosity), and rapid, indistinct progression of neovascularization (ROP disease) [6].…”

Section: Introductionmentioning

confidence: 99%

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Aggressive Posterior Retinopathy of Prematurity Is Associated with Multiple Infectious Episodes and Thrombocytopenia

et al. 2016

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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.

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“…Repeated studies have revealed that no infant during the years 2008-2012 has been treated for ROP before 32 weeks PMA. [3][4][5] Hence, our guidelines suggesting the start of examination in very premature infants at 31 weeks PMA, still seem safe in our country. Also, as stated by Kontos et al, 1 this saves many tiny babies from stressful examinations and also several ophthalmologists from unnecessary work.…”

Section: Sir Effectiveness Of the Present Rop Screening Protocolmentioning

confidence: 99%

Screening for retinopathy of prematurity can be started in postmenstrual week 31 in very premature babies!

Holmström

Hellström

Jakobsson

et al. 2016

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Five years of treatment for retinopathy of prematurity in Sweden: results from SWEDROP, a national quality register

Abstract: The present study reveals similar incidences of ROP and frequencies of treatment during the 5-year study period. Many surgeons were involved in treatment of a rather limited number of infants. The results call for national discussions on organisation of ROP treatment.

Cited by 29 publications

References 16 publications

International variations and trends in the treatment for retinopathy of prematurity

International variations and trends in the treatment for retinopathy of prematurity

Aggressive Posterior Retinopathy of Prematurity Is Associated with Multiple Infectious Episodes and Thrombocytopenia

Screening for retinopathy of prematurity can be started in postmenstrual week 31 in very premature babies!

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