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BackgroundThis study aims to investigate the incidence and the relative risk factors of retinopathy of prematurity (ROP) and posterior-ROP (P-ROP): ROP in Zone I and posterior Zone II, as well as to analyze the occurrence of surgical treatment of ROP and to evaluate the short term outcome of the disease in Italy.MethodsIt is a prospective multicenter observational study; all infants with a birth weight (BW) ≤ 750 g and/or a gestational age (GA) ≤27 weeks born between January 1st 2008 and December 31st 2009 in 25 III level Italian neonatal intensive care units were eligible for the study.Results421 infants were examined: 265 (62.9%) developed ROP and 102 (24.2%) P-ROP.Following the multivariate analysis erythropoietin-therapy (p < 0.0001) and intraventricular hemorrhage (IVH) (p = 0.003) were significantly associated with ROP while gestational age ≤24 weeks (p = 0.011) and sepsis (p = 0.002) were associated with the onset of P-ROP. Eighty nine infants (34%) required surgical treatment; following the multivariate analysis P-ROP was an independent factor associated with the need of surgical treatment (p < 0.0001). A favorable outcome was reported in 251 (94.7%) newborns affected by ROP. Adverse outcome occurred in 14 patients: all of them underwent surgery and showed P-ROP.ConclusionsP-ROP is the most aggressive type of ROP. It associates with lower GA and sepsis. Obstetricians and Neonatologists must focus on the reduction of severe preterm births and on the prevention of neonatal early and late onset sepsis in order to reduce the incidence of P-ROP.

The objective of this paper is to evaluate the effect of different prevention strategies on the rate of early-onset neonatal group B streptococcus (GBS) disease and mortality. We compared the neonatal mortality and morbidity rates associated with early-onset GBS disease in three periods characterized by different prevention strategies, including no screening for GBS during pregnancy and no standardized chemoprophylaxis (1/1987 to 12/1990), antibiotic prophylaxis only with risk factors for GBS (1/1991 to 12/1994), and universal screening for GBS with rectovaginal cultures and chemoprophylaxis for women with positive results or risk factors (1/1995 to 12/1999). Statistical analysis included Fisher's exact test and Chi-square, with a two-tailed p <0.05 considered significant. The yearly prevalence of positive GBS cultures was similar throughout the screening period (mean 18%, range 16 to 19%). Compared with the no prophylaxis group (rate = 4/8,573), introduction of universal screening (rate = 0/13,754, p = 0.02) but not of prophylaxis for risk factors alone (rate = 1/10,303, p = 0.18) significantly decreased the occurrence of GBS-specific neonatal mortality. Universal screening decreased, though not significantly, the GBS-specific neonatal morbidity rates compared with a policy based on risk factors alone (0.4/1000 vs. 0.8/1000, p = 0.29). Our study had a power to detect a 0.7/1000 difference in the rate of specific morbidity between the two chemoprophylaxis policies (alpha = 0.05, beta= 0.80). Intrapartum prophylaxis for GBS, using universal screening or risk factors, is associated with a significant reduction in the specific neonatal mortality rate compared with no prophylaxis. Universal screening for GBS leads to a decrease in specific GBS morbidity compared with screening using risk factors alone.

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