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Retinopathy of prematurity in extremely low birth weight infants
Insights
Improved survival rates for extremely low birth weight (ELBW) infants did not lead to more severe retinopathy of prematurity (ROP) or blindness. This study tracked ELBW infants, finding better survival without increased ROP-related visual impairment.
Area of Science:
- Neonatalogy
- Ophthalmology
- Perinatal Medicine
Background:
- Survival rates for extremely low birth weight (ELBW) infants have improved over time.
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- The relationship between increased ELBW survival and ROP outcomes requires ongoing investigation.
Purpose of the Study:
- To assess survival rates, ROP incidence and severity, and blindness rates in ELBW infants.
- To determine if rising ELBW survival correlates with increased severe ROP or blindness.
- To analyze trends in ROP outcomes over two distinct 8-year periods.
Main Methods:
- A prospective cohort study was conducted on ELBW infants (birth weight 500-999g).
- Infants were grouped into two cohorts based on birth year: 1977-1984 and 1985-1992.
- Survival rates and ophthalmological outcomes, including ROP assessment and visual acuity, were compared between the cohorts.
Main Results:
- Survival to hospital discharge significantly increased from 34.5% to 53.7% between the two periods.
- The overall incidence of ROP decreased significantly from 48.2% to 35.8%.
- Rates of severe ROP and ROP-related blindness remained low and did not significantly increase with improved survival.
Conclusions:
- Increased survival rates of ELBW infants are not necessarily associated with a higher incidence of severe ROP or blindness.
- These findings suggest that advancements in neonatal care may be improving outcomes for ELBW infants.
- Careful monitoring and management of ROP remain crucial in neonatal intensive care units.
Objective:
To review the survival rate, the incidence and severity of retinopathy of prematurity (ROP), and the rate of blindness caused by ROP in extremely low birth weight (ELBW, birth weight 500 to 999 g) infants born between January 1, 1977, and December 31, 1992, and to determine whether increasing survival rates of ELBW infants are accompanied by an increase in the rates of severe ROP or blindness.
Design:
Prospective cohort study of ELBW infants. Survival rates and visual outcomes were contrasted between children born in successive 8-year periods (1977 through 1984 and 1985 through 1992, inclusive).
Setting:
The premature nurseries at the Royal Women's Hospital, Melbourne, a level-3 perinatal center.
Patients:
Of 1001 inborn ELBW infants over the 16-year period, 457 (45.7%) survived their initial hospitalization: of the survivors, 434 (95.0%) were examined by the ophthalmologist, starting at 2 weeks of age if possible, then 2-weekly unit discharge. Children were reassessed after discharge at ages ranging from 1 to 10 years.
Results:
Survival rates to hospital discharge rose significantly over time, from 34.5% (145/420) in 1977 through 1984, to 53.7% (312/581) in 1985 through 1992 (odds ratio [OR] 2.2, 95% confidence interval [CI] 1.7 to 2.8). Of the 434 surviving ELBW infants seen by the ophthalmologist, ROP was detected in 48.2% (68/141) in 1977 through 1984, which dropped significantly to 35.8% (105/293) in 1985 through 1992 (OR 0.6, 95% CI 0.4 to 0.9). Severe ROP (bilateral stages 3 to 5) was detected in 25.5% (36/141) in 1977 through 1984, and 17.7% (52/293) in 1985 through 1992, but the reduction was not quite statistically significant (OR 0.6, 95% CI 0.4 to 1.0). Bilateral blindness (visual acuity in each eye less than 6/60) caused by ROP occurred in only 4 (0.88%) survivors overall, 2 in each era.
Conclusion:
The increase in the survival rate of ELBW infants is not always accompanied by an increase in the rate of severe ROP or blindness, at least for ELBW infants born in some large level-3 centers.