Retinopathy of prematurity: Risk factors and variability in Canadian neonatal intensive care units

Thomas, Karen A.; Shah, Prakeshkumar S; Canning, Roderick; Harrison, Adele; Lee, S.K.; Dow, Kimberly

doi:10.3233/npm-15814128

Cited by 60 publications

(63 citation statements)

References 36 publications

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“…Our data also suggest that males have an increased risk of ROP, similar to other studies 5 11 13. In contrast, delivery by CS, which has become more frequent for very preterm infants during this time period,14 has not been previously reported as a risk factor for severe ROP.…”

Section: Discussionsupporting

confidence: 90%

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: Discussionsupporting

confidence: 90%

International variations and trends in the treatment for retinopathy of prematurity

et al. 2017

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“…[4][5][6] The risk factors for ROP include low gestational age (GA), low birth weight (BW), presence of comorbidities (eg patent ductus arteriosus [PDA], necrotising enterocolitis (NEC), intraventricular haemorrhage [IVH]), and a high level of supplemental oxygen. [7][8][9] Those born at extreme prematurity and with extremely low birth weight (ELBW) are at high risk of severe ROP development. The British Guidelines published by the Royal College of Paediatrics and Child Health in 2008 recommended screening for ROP in premature infants with GA of <32 weeks or BW of <1501 g. 10 The American Guidelines published by the American Academy of Pediatrics in 2013 recommended screening for ROP if GA was ≤30 weeks or BW ≤1500 g. Selected infants with BW of 1500 to 2000 g or GA of >30 weeks with an unstable clinical course should also be screened if they were assessed by the attending neonatologist to be at high risk of ROP.…”

Section: Discussionmentioning

confidence: 99%

“…The association between PDA and risk of ROP development has been shown in previous studies. 8,9 It has been postulated that persistent leftto-right shunt results in low systemic blood flow and retinal ischaemia, and thus is associated with higher risk of ROP development. 8,29 In addition, use of indomethacin to close PDA might reduce retinal blood flow and contribute to ROP development.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 It has been postulated that persistent leftto-right shunt results in low systemic blood flow and retinal ischaemia, and thus is associated with higher risk of ROP development. 8,29 In addition, use of indomethacin to close PDA might reduce retinal blood flow and contribute to ROP development. 8,30 Dilated fundal examination in ROP screening is a stressful event for premature infants.…”

Section: Discussionmentioning

confidence: 99%

“…8,29 In addition, use of indomethacin to close PDA might reduce retinal blood flow and contribute to ROP development. 8,30 Dilated fundal examination in ROP screening is a stressful event for premature infants. It is important to screen only those who are at risk to avoid unnecessary examination and stress.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Screening for retinopathy of prematurity and treatment outcome in a tertiary hospital in Hong Kong

Lai

Fan

et al. 2016

Hong Kong Med J

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Validation of the Colorado Retinopathy of Prematurity Screening Model

et al. 2018

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The Colorado Retinopathy of Prematurity (CO-ROP) model uses birth weight, gestational age, and weight gain at the first month of life (WG-28) to predict risk of severe retinopathy of prematurity (ROP). In previous validation studies, the model performed very well, predicting virtually all cases of severe ROP and potentially reducing the number of infants who need ROP examinations, warranting validation in a larger, more diverse population. OBJECTIVE To validate the performance of the CO-ROP model in a large multicenter cohort. DESIGN, SETTING, PARTICIPANTS This study is a secondary analysis of data from the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study, a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada between January 2006 and June 2012 of 6351 premature infants who received ROP examinations. MAIN OUTCOMES AND MEASURES Sensitivity and specificity for severe (early treatment of ROP [ETROP] type 1 or 2) ROP, and reduction in infants receiving examinations. The CO-ROP model was applied to the infants in the G-ROP data set with all 3 data points (infants would have received examinations if they met all 3 criteria: birth weight, <1501 g; gestational age, <30 weeks; and WG-28, <650 g). Infants missing WG-28 information were included in a secondary analysis in which WG-28 was considered fewer than 650 g. RESULTS Of 7438 infants in the G-ROP study, 3575 (48.1%) were girls, and maternal race/ethnicity was 2310 (31.1%) African American, 3615 (48.6%) white, 233 (3.1%) Asian, 40 (0.52%) American Indian/Alaskan Native, and 93 (1.3%) Pacific Islander. In the study cohort, 747 infants (11.8%) had type 1 or 2 ROP, 2068 (32.6%) had lower-grade ROP, and 3536 (55.6%) had no ROP. The CO-ROP model had a sensitivity of 96.9% (95% CI, 95.4%-97.9%) and a specificity of 40.9% (95% CI, 39.3%-42.5%). It missed 23 (3.1%) infants who developed severe ROP. The CO-ROP model would have reduced the number of infants who received examinations by 26.1% (95% CI, 25.0%-27.2%). CONCLUSIONS AND RELEVANCE The CO-ROP model demonstrated high but not 100% sensitivity for severe ROP and missed infants who might require treatment in this large validation cohort. The model requires all 3 criteria to be met to signal a need for examinations, but some infants with a birth weight or gestational age above the thresholds developed severe ROP. Most of these infants who were not detected by the CO-ROP model had obvious deviation in expected weight trajectories or nonphysiologic weight gain. These findings suggest that the CO-ROP model needs to be revised before considering implementation into clinical practice.

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Retinopathy of prematurity: Risk factors and variability in Canadian neonatal intensive care units

Abstract: Younger, smaller and sicker male infants had higher adjusted risks of severe ROP and rates varied significantly among sites.

Cited by 60 publications

References 36 publications

International variations and trends in the treatment for retinopathy of prematurity

International variations and trends in the treatment for retinopathy of prematurity

Screening for retinopathy of prematurity and treatment outcome in a tertiary hospital in Hong Kong

Validation of the Colorado Retinopathy of Prematurity Screening Model

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