International variations and trends in the treatment for retinopathy of prematurity

Abstract

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.

Incidence of retinopathy of prematurity (ROP) and ROP treatment in Switzerland 2006–2015: a population-based analysis

“…A recently published comparison of data from 10 neonatal networks including patients from 24 0/7 to 27 6/7 weeks was therefore limited to patients who were above the locally defined limit of viability in some countries 16. This study revealed a wide variation in ROP treatment incidence between neonatal national networks.…”

“…Furthermore, thresholds to withdraw therapy in the tiniest and sickest infants who have highest risk for ROP might also differ between countries. For example, Japan shows high survival rates at the limit of viability at 22–24 weeks GA18 but higher rates of ROP therapy 16…”

The International Network for Evaluating Outcomes (iNeo) of neonates: evolution, progress and opportunities

“…Untangling composite outcome factors further, we assessed differences in mortality among neonates born at 24-30 weeks' GA and reported that the survival rate at specific GAs varied between countries; in particular, at 24 weeks' GA survival varied from ~35% to 84% between countries (29). Similar to mortality, the rates of any ROP varied markedly between networks, especially the rates of treated ROP varied between 4% to 30% between countries (30). Further evaluation of the variation in rates of sepsis (31), NEC (32), and severe brain injury (33) between countries/datasets are underway.…”

Information technology infrastructure, quality improvement and research: the UK National Neonatal Research Database

“…The NNRD is also the UK data source for international collaborations. The International Network for Evaluation of Outcomes of Neonates (iNeo) is a quality improvement project based on collaborative comparisons of population-based international healthcare for neonates led by the University of Toronto (http://ineonetwork.org) (28) that has produced a number of outputs (29)(30)(31)(32)(33)(34)(35)(36)(37)(38). eNewborn is a pan-European preterm benchmarking platform (39).…”