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Temporal trends and risk factors for retinopathy of prematurity: insights from a population-based study (1995-2021)
Rachel Shemesh1, Brian Reichman2, Tzipora Strauss3
1Tel Aviv University's Gray Faculty of Medical & Health Sciences, Tel-Aviv, Israel; Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.
Insights
Retinopathy of prematurity (ROP) incidence significantly decreased from 1995-2021, but recent trends show an increase in infants with sepsis, necrotizing enterocolitis, or patent ductus arteriosus. Further research may guide earlier screening and interventions for these high-risk infants.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Temporal trends and associated factors of ROP require ongoing investigation.
Purpose of the Study:
- To evaluate temporal trends in ROP incidence.
- To identify demographic and clinical factors associated with ROP in very low birthweight infants.
Main Methods:
- Population-based observational cohort study using the Israel national very low birthweight infant database.
- Analysis of 16,257 infants born at 23-29 weeks gestation.
- Multivariable logistic regression and Cochran-Armitage Trend Test for trend analysis.
Main Results:
- ROP incidence declined from 32.9% (1995-2000) to 16.0% (2017-2021) (p < 0.0001).
- Sepsis, surgically treated necrotizing enterocolitis (NEC), and surgically treated patent ductus arteriosus (PDA) were independently associated with ROP.
- ROP rates increased in infants with sepsis, surgically treated PDA, or surgically treated NEC during 2017-2021.
Conclusions:
- ROP odds decreased significantly over 1995-2021, with an attenuated decline in the last decade.
- The association between surgically treated PDA/NEC and ROP warrants further investigation.
- Earlier ROP screening and therapeutic interventions may be beneficial for high-risk infants.
Objective:
The aim of this population-based study was to evaluate the temporal trends in the incidence of retinopathy of prematurity (ROP) and the demographic and clinical factors associated with ROP.
Methods:
In this population-based observational cohort study data from the Israel national very low birthweight infant database were used. Following exclusions, the final study population comprised 16,257 infants born at 23-29 weeks. The independent effect of variables associated with ROP was assessed using multivariable logistic regression. P values for trend were determined by applying the Cochran-Armitage Trend Test.
Results:
The rates of ROP decreased from 32.9% in the years 1995-2000 to 16.0% in 2017-2021 (p < 0.0001). In comparison to the reference epoch (1995-2000), the adjusted odds ratio (OR) [95% confidence interval] for ROP, were significantly lower in 2001-2006 (OR 0.68 [0.59-0.77]), in 2007-2011 (OR 0.36 [0.31-0.42]), in 2012-2016 (OR 0.31 [0.26-0.36]), and in 2017-2021 (OR 0.32 [0.27-0.39]). Sepsis (OR 1.67 [1.52-1.83]), surgically treated necrotizing enterocolitis (NEC) (OR 1.86 [1.49-2.32]) and surgically treated patent ductus arteriosus (PDA) (OR 1.88 [1.56-2.27]) were associated with ROP. Among the infants with sepsis, surgically treated PDA or surgically treated NEC, the rates of ROP increased in the 2017-2021 epoch.
Conclusions:
The odds for ROP decreased by over two-thirds throughout the period 1995-2021, although the decline was attenuated in the recent decade. In view of the independent association found between surgically treated PDA or NEC and ROP, and the increasing rates of ROP in these infants, further studies may elucidate whether earlier ROP screening and possibly earlier therapeutic interventions may be appropriate for these infants.
