Abstract
Purpose :
Following a national inventory (2009), a new Retinopathy of Prematurity (ROP) guideline was introduced in the Netherlands in 2013, allowing a predicted 29% reduction in screening by using risk-based inclusion criteria. Further, the study revealed that hospital transfer significantly increased the risk of not being screened, upon which designation of local responsibility was considered obligatory. Moreover, the early treatment for ROP (ETROP) criteria were emphasized as the study revealed that they were not yet sufficiently implemented. The aim of this second, consecutive national inventory was to investigate the influences of the new guideline and provide an up-to-date inventory on the incidence, screening logistics and treatment of (severe) ROP.
Methods :
A multicentre prospective nationwide population-based study including data of all preterm infants born in 2017 in the Netherlands and considered eligible for ROP screening. Anonymized data from ophthalmologists, neonatologists and paediatricians were merged. Outcome data were compared to data from the 2009 inventory.
Results :
All 80 Dutch hospitals involved in ROP screening participated in this inventory. In total, 1288 infants were reported of which 1090 (84.6%) were screened for ROP (2009: 2033 infants, 1688 (83.0%) screened). Mean gestational age and birth weight in infants without ROP were 29.5 (±1.9) weeks and 1243 (±311) grams respectively vs. 27.4 (±1.9) weeks and 967 (±284) grams in the group with ROP (p<0.001). ROP developed in 310 (28.4%) infants, of which 262 (23.9%) stage 1-2, 49 (4.5%) ≥stage 3 and 37 (3.3%) type 1 ROP. Treatment, all primarily laser photocoagulation, was performed in 39 (3.6%) infants (2009: ROP in 324 infants, 30 ≥stage 3, 17 treated). The predominant cause for not being screened was death before first exam (60.6%), followed by the ophthalmologist not qualifying the infant as eligible for screening based on the new criteria (28.3%). Transfer did not increase the risk for not being screened. Improved classification of severe ROP confirms better ETROP-adherence.
Conclusions :
A reduction in screening of 35% was accomplished while maintaining high detection of both mild and severe ROP. Measurements concerning transfer logistics and local responsibility resulted in overall timely performed screening and a low number lost to follow-up.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.