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Screening for Retinopathy of Prematurity in Very Preterm Children: The EPIPAGE-2 Cohort Study
Thibaut Chapron1,2, Georges Caputo3, Vèronique Pierrat4,5
1Epidemiology and Statistics Research Center/CRESS, INSERM, INRA, University of Paris, Paris, France, tchapron@for.paris.
Insights
Retinopathy of prematurity (ROP) screening is inconsistent in very preterm infants, with many not receiving timely eye exams. Wide-angle imaging and local protocols improve screening compliance for this blinding disease.
Area of Science:
- Neonatal ophthalmology
- Public health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of blindness in premature infants.
- Current ROP screening practices are not well-evaluated, highlighting a gap in understanding screening adherence.
Purpose of the Study:
- To determine the prevalence of ROP screening in very preterm infants.
- To identify individual and center-related factors influencing ROP screening and its timeliness.
Main Methods:
- Analysis of the prospective, population-based EPIPAGE-2 cohort study of premature births in 2011.
- Inclusion of infants born before 32 weeks' gestation without severe malformations.
- Mixed-effects models used to assess factors associated with screening achievement and compliance.
Main Results:
- 70.5% of eligible infants underwent ROP screening, with significant variability across neonatal units.
- Screening rates were higher for infants with lower gestational age and birth weight, and those with severe bronchopulmonary dysplasia or neurological issues.
- Neonatal units utilizing wide-angle imaging showed higher screening odds, while those lacking a local ROP protocol had significantly lower odds.
Conclusions:
- A substantial proportion of very preterm infants are not screened for ROP, and many who are screened experience delays.
- Wide-angle imaging systems appear to enhance screening compliance.
- The absence of local ROP screening protocols is a barrier to timely and adequate screening.
Introduction:
Retinopathy of prematurity (ROP) is a blinding disease that requires screening by retinal examination. Screening practices are rarely evaluated. We aimed to determine the prevalence of ROP screening in very preterm infants and individual- and center-related factors associated with ROP screening.
Methods:
Data were extracted from the EPIPAGE-2 cohort, a French prospective population-based study of premature births in 2011. Children born before 32 weeks' gestation (WG) without severe malformation and alive at the recommended time for ROP screening were included. Outcome measures were achievement of ROP screening and compliance with recommended screening timeline. Individual- and center-related factors associated with both measures were studied using mixed models.
Results:
Among 3,077 eligible infants, 2,169 (70.5%) had a ROP screening, ranging from 96% at 24 WG to 50% at 31 WG. Large variability among units was observed. Individual characteristics associated with screening were low gestational age, low birth weight, severe bronchopulmonary dysplasia or neurological lesions, and transfer between neonatal units during the screening period. Odds of screening were higher in neonatal units using wide-angle imaging (odds ratio 2.65 [95% confidence interval 1.17-6.01]) but decreased in units without a local protocol for ROP screening (0.03 [0.01-0.09]). Among screened children, 1,641/2,169 (75.7%) were screened according to recommended timeline. Delayed screening was associated with low gestational age, severe bronchopulmonary dysplasia or necrotizing enterocolitis, and absence of local protocol for ROP screening.
Discussion/Conclusions:
In this large cohort study of infants born very preterm, almost one-third were not screened for ROP. Children most at risk for ROP were the best screened but often with delay. The higher compliance of neonatal units using wide-angle imaging systems supports its use.
