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Retinopathy of prematurity in infants of 24-30 weeks' gestational age
C G Keith1, L W Doyle, W H Kitchen
1Division of Paediatrics, Royal Women's Hospital, Carlton, VIC.
Insights
Improved infant care led to better survival rates for premature infants. Despite increased survival, advanced retinopathy of prematurity in survivors was manageable, not epidemic.
Area of Science:
- Neonatalogy
- Ophthalmology
- Perinatal Medicine
Background:
- Premature infants (24-30 weeks gestation) face significant mortality and morbidity risks.
- Retinopathy of prematurity (ROP) is a major concern for premature infants, with advanced stages posing severe visual impairment risks.
Purpose of the Study:
- To analyze trends in mortality and retinopathy of prematurity (ROP) among very premature infants over a decade.
- To assess the impact of improved medical care on survival rates and ROP prevalence in this vulnerable population.
Main Methods:
- Retrospective analysis of 1114 infants (24-30 weeks gestation) admitted between 1977 and 1986.
- Statistical evaluation of mortality rates and ROP stages (3-4) in relation to gestational age and changes over time.
Main Results:
- Overall survival rate was 68% (757/1114).
- Mortality decreased by 11.5% over the decade, and survival for infants with stage 3-4 ROP increased by 6.8%.
- Advanced ROP prevalence rose in immature survivors but remained non-epidemic, linked to increased survival of high-risk infants.
Conclusions:
- Advances in neonatal care significantly improved survival for very premature infants.
- While advanced ROP increased among survivors, it was manageable and associated with the successful resuscitation of increasingly immature infants.
Abstract:
Over the 10-year period from January 1, 1977 to December 31, 1986, 1114 infants with gestational ages of 24 to 30 completed weeks were cared for on a long-term basis in our nursery; 757 (68%) infants survived. As expected, both the mortality rate and the prevalence of stage-3 or stage-4 retinopathy of prematurity among survivors fell with increasing maturity at birth (P less than 0.0001). Adjusting for gestational age, and excluding infants with lethal malformations, the mortality rate decreased significantly (P = 0.018) over time by an estimated 11.5%; also the survival rate of infants with at least stage-3 retinopathy of prematurity increased significantly (P = 0.005) by an estimated 6.8%. In other words, for every 10 additional survivors over the decade, six survivors would have been expected to show at least stage-3 retinopathy of prematurity in either eye. Although the prevalence of advanced stages of retinopathy of prematurity increased in immature survivors, it was not in epidemic proportions; however, it was more likely to be related to the survival of the increasing numbers of at-risk immature infants who, in earlier times, would have died.