Incidence of retinopathy of prematurity in Germany: evaluation of current screening criteria

Abstract

ObjectiveTo evaluate current screening criteria for retinopathy of prematurity (ROP) by investigating the incidence of ROP requiring treatment in infants with gestational age (GA) ≥30 weeks or postmenstrual age (PMA) <32 weeks in Germany.MethodsThree patient databases were analysed, that is, the German Quality Assurance Procedure in Neonatology (years 2011–2017; n=52 461 infants screened for ROP, 1505 infants treated for ROP), the German Retina.net ROP Registry (years 2011–2018; n=281 treated infants) and the ROP screening programme of two German university hospitals (years 2012–2016; n=837 screened infants).ResultsIn the analysed cohorts, infants with GA ≥30 weeks represented 33.1%–38.5% of the screening populations but only 1.40%–1.42% of the cases requiring ROP treatment. In a cohort of 281 infants treated for ROP, all 4 infants with GA ≥30 weeks had additional risk factors for ROP including prolonged oxygen supplementation and/or significant comorbidities. Five infants (1.8%) were treated at 32 weeks PMA and none at PMA <32 weeks.ConclusionsIn the investigated cohorts, preterm infants with GA ≥30 weeks carried a very low or no risk for developing treatment-requiring ROP unless additional risk factors were present, and no treatment was performed earlier than 32 weeks PMA. These findings are of relevance for the ongoing re-evaluation of ROP screening criteria.

Retrospective validation of the postnatal Growth and Retinopathy of Prematurity (G-ROP) criteria in a Swiss cohort

“…Larsen et al have suggested that modifying the GA threshold to < 30 weeks in the screening guidelines would lower the burden of screening examinations with acceptable impact on the sensitivity of screening programs [ 3 ]. Indeed, applying this modified GA limit of < 30 weeks would not have altered the screening sensitivity for predicting treatment-required ROP in this cohort.…”

“…While in some high-income countries the sensitivity of G-ROP criteria to predict type 1 ROP in validation studies was 100%, [ 11 , 12 ] lower sensitivity (91.9%) has been suggested in less mature healthcare systems such as Turkey [ 13 ]. These differences may have resulted from different neonatal care practices and different characteristics of the premature population in low- and middle-income countries [ 15 ].In Switzerland and Germany, less than 1% of infants with GA > 30 weeks developed treatment requiring ROP, [ 3 , 17 ] but in Mexico, over one-third of preterm infants with GA > 32 weeks may develop ROP type 1 [ 18 ]. Moreover, careful attention is needed in countries with less tightly controlled use of oxygen supplementation, as postnatal weight gain is not a reliable predictive factor of ROP when an infant is treated with excessive oxygen supplementation [ 14 ].…”

“…In fact, less than 10% of examined infants with the current screening criteria develop a treatment requiring ROP (type 1 ROP). Therefore, the vast majority of ophthalmic examinations are performed in children who never need an intervention [ 3 ].…”

“…To minimize the burden of screening, alternative criteria have been proposed by several groups [ 3 – 9 ]. One of the most promising algorithms, the G-ROP model, was developed using a large database [ 10 , 11 ].…”

The safety and feasibility of the screening for retinopathy of prematurity assisted by telemedicine network during COVID-19 pandemic in Wuhan, China

“…In our study, the incidence of ROP screening both in 2019 and 2020 was 6.7%, lower than previous reports [1,14], which may be due to the reason that the infants without systematic diseases in outpatient clinic had relatively high gestational ages and birth weights. It was well-known that low gestational age and birth weight were still the major risk factors for ROP [15,16]. In North America, new ROP screening criteria [17,18] include gestational age < 28 weeks and weight gain at 40 days after birth, which had higher sensitivity and specificity for ROP type 1 than current criteria, and lead to 30% less screening population [17].…”