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New modifications of Swedish ROP guidelines based on 10-year data from the SWEDROP register
Gerd Holmström1, Ann Hellström2, Lotta Gränse3
1Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden gerd.holmstrom@neuro.uu.se.
Insights
Improved neonatal care has not changed retinopathy of prematurity (ROP) incidence but increased treatment frequency. Screening guidelines for premature infants may be modified to reduce unnecessary examinations.
Area of Science:
- Neonatal ophthalmology
- Public health
- Pediatric screening
Background:
- Advances in neonatal care have increased survival rates for extremely premature infants.
- This has led to a hypothesis that the incidence and treatment of retinopathy of prematurity (ROP) may have changed, necessitating guideline modifications.
Purpose of the Study:
- To analyze trends in ROP incidence and treatment over a decade in relation to gestational age (GA) at birth.
- To evaluate the impact of improved neonatal care on ROP outcomes and screening practices.
Main Methods:
- Retrospective analysis of data from the Swedish National ROP Register (2008-2017).
- Inclusion of all infants born with a gestational age (GA) at birth ≤30 weeks.
- Calculation of ROP incidence, treatment frequency, and examination numbers relative to GA.
Main Results:
- Of 7249 infants, 31.9% had ROP and 6.1% required treatment; no infant with GA 30 weeks was treated.
- ROP incidence remained stable, but treatment frequency significantly increased (p=0.023).
- Infants with ROP and treated ROP showed reduced GA and birth weight over time; detection of ROP occurred earlier in postnatal age for the most immature infants.
Conclusions:
- Proposed modification of Swedish ROP screening guidelines: screen only infants with GA <30 weeks and postpone initial examination for GA 26-29 weeks.
- These changes could reduce stressful examinations for infants and decrease overall eye examinations by at least 20%.
Background/Aims:
During the last decade, improved neonatal care has resulted in increased survival of the most immature infants and improved health of more mature infants. We hypothesise that this has affected incidence and treatment of retinopathy of prematurity (ROP), enabling guidelines for screening to be modified.
Methods:
In Sweden, all infants with gestational age (GA) at birth ≤30 weeks are screened for ROP. Results are registered in a web-based register, Swedish National ROP Register, with a coverage rate of 97%. Incidence of ROP and frequency of treatment, aspects on natural course of ROP and number of examinations, are calculated in relation to GA at birth in infants born during 2008-2017.
Results:
Of 7249 infants, 31.9% (2310) had ROP and 6.1% (440) were treated. No infant with GA 30 weeks was treated. Incidence of ROP remained similar, but frequency of treatment increased (p=0.023). Over time, GA and birth weight were reduced in infants with ROP and with treated ROP. In the most immature infants, postmenstrual age was lower and postnatal age was higher when any ROP and stage 3 ROP were first detected (p<0.001). At treatment, postmenstrual but not postnatal age of the infant was associated with GA (p<0.001). During the 10-year period, 46 038 examinations were performed.
Conclusion:
Modification of Swedish guidelines is proposed, including only infants with a GA of <30 weeks and postponing the first examination with 1 week in infants with GA 26-29 weeks. This would spare many infants from stressful examinations and reduce eye examinations with at least 20%.
