Surveillance for retinopathy of prematurity in a Danish country. Epidemiological experience over 20 years
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Published on: September 3, 2020
Hans C Fledelius1, Birgit Kjer
1Department of Ophthalmology, Rigshospitalet, University of Copenhagen, Denmark. rh03217@rh.dk
Insights
Retinopathy of prematurity (ROP) rates increased significantly in a Danish county, interrupting a previous downward trend. Despite this, lower screening limits for gestational age and birthweight may now be appropriate.
Area of Science:
- Neonatal ophthalmology
- Public health surveillance
- Pediatric epidemiology
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Monitoring ROP trends is crucial for assessing neonatal care quality.
- Previous studies in this Danish county showed a continuous improvement in ROP outcomes.
Purpose of the Study:
- To analyze updated trends in retinopathy of prematurity (ROP) in a Danish county from 1982 to 2001.
- To evaluate changes in ROP frequency, severity, and risk factors over time.
- To inform potential adjustments to ROP screening guidelines.
Main Methods:
- Prospective surveillance of 132 infants born between 1998-2001 for ROP.
- Comparison with data from 1123 infants in five previous reports (1982-1997).
- Analysis focused on high-risk infants (gestational age/birthweight below national screening limits).
Main Results:
- The trend of continuous improvement in ROP outcomes was interrupted between 1998-2001.
- ROP incidence increased from 10% to 31% in high-risk infants compared to the prior period.
- Four cases required retinal ablation therapy, a significant increase from zero in the preceding period; however, no advanced ROP occurred in infants >30 weeks GA / 1500g BW.
Conclusions:
- The recent worsening trend in ROP necessitates attentive monitoring as a neonatal quality indicator.
- Despite the observed increase, a reduction in ophthalmic screening limits for gestational age and birthweight appears justifiable.
- Consideration should be given to lowering screening limits to 31 weeks gestational age and 1500g birthweight, informed by local and national data.
Purpose:
An updated analysis of the trends in a Danish county regarding retinopathy of prematurity (ROP), outlining its natural history over the years 1982-2001.
Methods:
Epidemiological data are given of the 132 infants in the county with birth years 1998-2001 prospectively under surveillance for ROP. The customary national screening limits of gestational age (GA) and birthweight (BW) of 32 weeks/1750 g were generally adhered to. The findings are compared to five previous consecutive reports of a similar set-up, now making a total of 1123 who have been under surveillance.
Results:
With focus on the 20 years' newborns at a higher risk for ROP in the county (GA/BW both under the above limits; n=591) the continuous improvement up to 1998--as reflected by ROP frequency, its severity, and risk levels according to GA/BW--appears to have been interrupted. Compared to the previous 4-year period, the percentage acquiring ROP in 1998-2001 increased from 10 to 31%, and four recent cases qualified for retinal ablation therapy, compared with zero in the previous 4-year period. However, there were no advanced stages (of at least ROP 3) in infants above 30 weeks/1500 g at delivery.
Conclusions:
(a) Using the ROP also as a neonatal treatment quality parameter, the present trend (progress stopped) should be followed attentively. So far, we have no clues regarding therapy-related or other causality. (b) Despite the suggested worsening, a lowering of the ophthalmic GA and BW screening limits now seems justifiable. With a view also to the high-risk Copenhagen data and the national childhood visual impairment register, a reduction of the values to 31 weeks/1500 g should be considered.
