Screening for retinopathy of prematurity in very preterm infants: Epipage 2 cohort study

Abstract

Purpose : Retinopathy of prematurity (ROP) is a severe blinding disease whose screening is recommended but the put into practice of these recommendations is rarely evaluated. The objective was to study the prevalence of fundus in very preterm infants as well as the individual factors and characteristics of the centers associated with the screening.

Methods : Our data was extracted from the Epipage-2 cohort, a national prospective population based study of births occurring between 22 and 34 completed weeks’ gestation (WG) in 2011. Children <32 WG without severe malformation alive at the recommended age for ROP screening were included. We performed two separate analyzes using nested mixed models; we studied 1) the achievement of the fundus and 2) its achievement on time according to the French recommendations in force in 2011.

Results : At the end, 70.5% (2169/3077) of children eligible for screening received a fundus examination. This rate decreased with WG from 96.4% at 24 WG to 49.9% at 31 WG. The infant characteristics associated with fundus examination were a small gestational age (p <0.001), low birth weight (p <0.001), presence of severe bronchodyspasia (p <0.01) or severe neurological lesions (p <0.01) as well as a transfer of the child during the screening period (p <0.001). Children hospitalized in units using wide angle imaging were better screened (OR 2.65 [1.17-6.01] p <0.001). The other characteristics of the centers (level, administrative status, volume of activity) were not significant.
Of the children screened, 75.7% (1641/2169) were on time. Factors associated with a fundus examination performed on time were a high gestational age (p <0.001), the use of wide angle imaging (OR 2.20 [1.06-4.58], p <0.01); while a low birth weight (p <0.001), presence of severe bronchodysplasia (p <0.001) or a necrotizing enterocolitis (p <0.001) were associated with a delay in the examination.

Conclusions : Children the most at risk of ROP were the best screened but the latest. A better compliance of the units using wide angle imaging system supports the benefit of its deployment and the setting of a sharing process between neonatal units regarding its cost.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.