High rate and large intercentre variability in retreatment of retinopathy of prematurity in infants born <24 gestational weeks

Abstract

ObjectivePrematurity is a major risk factor for retinopathy of prematurity (ROP). We aimed to elucidate ROP prevalence, treatment and retreatment in infants born before 24 gestational age (GA) weeks in a Swedish cohort.Methods and analysisInfants with completed ROP screening, born at &lt;24 GA weeks, 2007–2018 in Sweden were included. Data of GA, birth weight (BW), sex, neonatal morbidities, maximal ROP stage, aggressive posterior ROP (APROP), ROP treatments, treatment modality and treatment centre were retrieved.ResultsIn total, 399 infants, with a mean GA of 23.2 weeks (range 21.9–23.9) and a mean BW of 567 g (range 340–874), were included. ROP was detected in 365 (91.5%) infants, 173 (43.4%) were treated for ROP and 68 of 173 (39.3%) were treated more than once. As the first treatment, 142 (82.0%) received laser and 29 (16.1%) received intravitreal injection of antivascular endothelial growth factor (anti-VEGF). Retreatment was performed after first laser in 46 of 142 (32.4%) and in 20 of 29 (69.0%) after first anti-VEGF treatment. Retreatment rate was not associated with GA, BW or sex but with APROP, treatment method (anti-VEGF) and treatment centre where the laser was performed (p&lt;0.001). Twenty eyes progressed to retinal detachment, and two infants developed unilateral endophthalmitis after anti-VEGF treatment.ConclusionInfants, born at &lt;24 weeks’ GA, had high rates of treatment-warranting ROP and retreatments. Treatment centre highly influenced the retreatment rate after laser indicating that laser treatment could be improved in some settings.

National cohort of infants born before 24 gestational weeks showed increased survival rates but no improvement in neonatal morbidity

“…Persistent pulmonary hypertension of the newborn was diagnosed in 18%. Details of ROP development and treatment modality have been previously published 21 …”

“…Details of ROP development and treatment modality have been previously published. 21 NEC had been diagnosed in 21% and 14% had undergone surgery for NEC. IVH occurred in 51% and severe IVH grades 3–4 in 17% ( Table S3 ).…”

Retrospective evaluation of ophthalmological and neurological outcomes for infants born before 24 weeks gestational age in a Swedish cohort

“…Details about ROP outcomes in the whole cohort have been published previously. 22 At the last available ophthalmological examination, the median age was 4.8 years (range 0.5-13.2 years) and 31.0% (110/355) of the children were younger than 3.5 years of age.…”

“…Of the children with available ophthalmological records, 92.5% (329/355) had an ROP diagnosis, and 47.0% (167/355) had been treated for ROP. Details about ROP outcomes in the whole cohort have been published previously 22…”

“…Infants born extremely preterm have a high risk of somatic and neurological disorders with life-long consequences 3–5. Retinopathy of prematurity (ROP) is a potentially sight-threatening disease affecting primarily the most extremely preterm infants 6 7. Ophthalmological problems and visual impairment are common after extremely preterm birth, even in the absence of previous ROP 8 9.…”