Naveed Hussain , Jonathan Clive and Vineet Bhandari 1997 −

Objective. To report the current incidence and the need for surgery for retinopathy of prematurity (ROP) in neonates (22–36 weeks’ gestational age [GA], July 1, 1989 through June 30, 1997). Study Design. Retrospective analyses using computerized perinatal database kept on all admissions, a review of patient charts, and eye examination log books. Setting. Level 3 regional referral NICU. Patients. A total of 2528 infants <37 weeks’ GA were admitted during this time. Of these infants, 950 met the criteria for eye examination beginning at 4 to 6 weeks of age and repeated every 2 weeks until complete vascularization of the retina or death or discharge. Results. The incidence of ROP was (202/950) 21.3% for any stage and 4.6% (44/950) for stage 3 ROP or greater. No ROP was noted in infants born at >32 weeks’ GA. No infant born at >28 weeks needed retinal surgery. Using birth weight (BW) criteria, stage 3 ROP was not noted in infants with BWs >1500 g; retinal surgery was not needed in infants with BWs >1000 g. A number of perinatal factors were associated with ROP on univariate analysis. However, using multiple logistic regression analyses of these factors, only GA and days on supplemental oxygen therapy were associated significantly with the development of ROP. Despite increased survival of extremely low BW infants, we found a considerable reduction in incidence and severity of ROP compared with reports from an earlier chronological period. However, infants <28 weeks’ GA or with BWs <1000 g were still at considerable risk for retinal surgical treatment for ROP. Conclusion. We conclude that the incidence and severity of ROP have decreased significantly in the present era of surfactant therapy. Pediatrics 1999;104(3). URL: http://www.pediatrics.org/cgi/content/full/104/3/e26; retinopathy, prematurity, incidence, morbidity, eye. ABBREVIATIONS. ROP, retinopathy of prematurity; LBW, low birth weight; NICU, neonatal intensive care unit; RDS, respiratory distress syndrome; GA, gestational age; BW, birth weight; SGA, small for gestational age; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia; BPD, bronchopulmonary dysplasia; NEC, necrotizing enterocolitis; CPAP, continuous positive airway pressure. Retinopathy of prematurity (ROP) is a significant problem in low birth weight (LBW) premature infants. Before surfactant became available for clinical use in the neonatal intensive care unit (NICU), an incidence of 11% to 60% was reported in the LBW population.1,2 The last major report of the incidence of ROP was published from the cryotherapy–retinopathy of prematurity (CRYOROP) study completed in 1987,3 which was conducted before surfactant use was approved for treatment of respiratory distress syndrome (RDS). A decade of continued advances in neonatal management, including the use of surfactant therapy and new methods of mechanical ventilation has improved most neonatal outcomes, but scarce data are available regarding the current incidence of ROP. It is also not clear whether the increased survival of smaller and sicker infants has resulted in an increased proportion of infants needing retinal surgery because of ROP.4,5 In their recent comprehensive review of ROP, Siatkowski and Flynn6 noted that “we are as lacking in basic epidemiologic data of varying rates of incidence [of ROP] in geographic areas . . . as we were in the 1940s and 1950s.” The goals of the present study are 1) to report the current incidence of ROP and the need for retinal surgery for severe ROP from a regional NICU and 2) to evaluate the contribution of various perinatal and neonatal factors to the risk for ROP.