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Premature infants with gestational age less than 25 weeks require increased ophthalmology resources for retinopathy
Vivian S Hawn1, Rakin Muhtadi1, Pamela Suman2
1Albert Einstein College of Medicine, Bronx, New York.
Insights
Infants born at less than 25 weeks gestational age (GA) have more severe retinopathy of prematurity (ROP) and require more eye exams. Healthcare providers must prepare for increased screening demands for these extremely premature infants.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Public Health
Background:
- Increasing survival rates of extremely low gestational age (GA) infants present challenges for retinopathy of prematurity (ROP) screening and treatment.
- The impact of rising survival rates of infants born at very low GA on ophthalmologic care for ROP is not well understood.
Purpose of the Study:
- To compare ophthalmologic examination and treatment rates for ROP in infants born at GA <25 weeks versus GA ≥25 weeks.
- To identify factors associated with the development of severe ROP in premature infants.
Main Methods:
- Retrospective study of infants meeting ROP screening criteria in two NICUs (January 2017 - June 2020).
- Analysis of variables including GA, birth weight, number of ophthalmology exams, ROP stage, and comorbidities.
- Statistical analysis using chi-squared, Fisher exact, t-tests, and logistic regression.
Main Results:
- Infants with GA <25 weeks had significantly more total eye exams (10 vs. 4.3), a higher average worst ROP stage (1.4 vs. 0.3), and a higher rate of type 1 ROP (21% vs. 1.4%) compared to those with GA ≥25 weeks.
- Mortality was higher in the GA <25 weeks group (37% vs. 8.11%).
- Multivariable analysis indicated GA was the only significant factor associated with developing type 1 ROP.
Conclusions:
- Infants born at <25 weeks GA experience more severe ROP and necessitate more frequent ophthalmologic examinations.
- ROP screening services must anticipate and plan for an increased screening workload due to the rising number of extremely premature infants.
Background:
It is unclear how increasing survival of low gestational age (GA) infants affects ophthalmologic screening and treatment rates for retinopathy of prematurity (ROP). This study compared the examination and treatment rates of infants born at GA of <25 weeks and those born at GA of at least 25 weeks.
Methods:
This was a retrospective study of patients who met institutional ROP screening criteria and were admitted to two neonatal intensive care units (NICUs) from January 2017 to June 2020. Variables analyzed were GA, birth weight, number of ophthalmology examinations, worst stage of ROP, presence of type 1 ROP, and comorbidities associated with ROP. The χ2, Fisher exact, and two-tailed t tests, as well as univariate and multivariable logistic regression, were used for statistical analysis.
Results:
Compared to the GA≥25 group, the GA<25 group had a higher number of total exams (10 vs 4.3 [P < 0.001]), higher average worst stage of ROP (1.4 vs 0.3 [P < 0.001]) and higher rate of type 1 ROP (21% vs 1.4% [P < 0.001]), as well as higher mortality (37% vs 8.11% [P < 0. 001]). Multivariable logistic regression analysis controlling for GA, sepsis, and number of transfusions revealed that only GA was significantly associated with developing type 1 ROP.
Conclusions:
Infants with GA <25 weeks had more severe ROP and required significantly more ophthalmologic examinations than GA ≥25. It is important for ROP services to plan for this increased screening load, especially if the number of such lower-weight infants in their NICUs increases.
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