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No advanced retinopathy of prematurity stages 4 or 5 in a large high-risk German cohort
Philipp S Muether1, Angela Kribs, Moritz Hahn
1Department of Vitreoretinal Surgery, Center of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany. philmuether@mac.com
Insights
Strict retinopathy of prematurity (ROP) screening and timely laser treatment in very premature infants prevented severe vision loss. Adherence to guidelines and specialized neonatal care were key factors in this German cohort.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Decreasing gestational age (GA) and birth weight (BW) increase ROP risk.
- This study examines ROP screening in a cohort of extremely premature infants.
Purpose of the Study:
- To review ROP screening outcomes in a very immature infant cohort in Germany.
- To assess the effectiveness of current screening and treatment guidelines.
Main Methods:
- Retrospective case series of 767 preterm infants screened between 2001-2009.
- Screening followed German guidelines for infants with GA < 32 weeks or BW < 1501 g, or GA ≥ 32 weeks with >3 days oxygen.
- Treatment involved dense laser coagulation as per criteria.
Main Results:
- No infant in the cohort developed stage 4/5 ROP.
- Treatment incidence was 7.0%.
- Lower GA, but not BW, was associated with increased treatment incidence.
Conclusions:
- Strict adherence to ROP screening and treatment guidelines prevented advanced ROP stages.
- Prompt, dense laser coagulation and specialized neonatal intensive care were crucial.
- This approach successfully avoided severe vision impairment in a high-risk population.
Background:
Retinopathy of prematurity (ROP) remains a major cause of juvenile blindness. As screening recommendations are refined, decreasing gestational age (GA) and birth weight (BW) constitute an increasing risk for ROP. This retrospective case series reviews the screening results of a very immature cohort in Germany.
Methods:
We conducted ROP screening according to the German guidelines of 1999: all preterm infants with a GA of < 32 weeks and/or a BW of < 1501 g, or with GA ≥ 32 weeks and postnatal oxygen treatment for > 3 days, were assigned for screening. Dense laser coagulation was performed according to the current treatment criteria.
Results:
All 767 consecutive inborn (patients born at the Department of Neonatology, University Hospital of Cologne, Germany) preterm infants of a tertiary medical centre of maximum care underwent complete screening from 2001 to 2009. The treatment incidence was 7.0%. No preterm infant developed stage 4/5 ROP. Mean GA and BW of untreated/treated preterm infants were 28.4/24.6 weeks and 1109/635 g, respectively. Increasing treatment incidence was associated with lower GA, but not with lower BW in logistic regression analysis.
Conclusion:
In this very immature high-risk cohort, advanced stages 4 and 5 were avoided throughout 9 years of screening. We suggest three factors that contributed to this outcome: (1) strict adherence to current ROP screening and treatment guidelines; (2) prompt and very dense laser coagulation if necessary; and (3) a specialised neonatal intensive care unit with experience of very immature babies.
