ObjectiveTo retrospectively analyze incidence and trends of retinopathy of prematurity (ROP) from 2004 to 2013 in Shenzhen. MethodsA total of 9100 preterm children (5401 males, 3699 females) were screened for ROP in Shenzhen from January 2004 to June 2013 using binocular ophthalmoscope or RetCam Ⅱ. First examination was performed from 4-6 weeks after birth. The birth weight was 520-2990 g with an average of (1710±410) g.The gestational age were 24-36 weeks with an average of (31.57±1.99) weeks. The gestational age of 208 children were <28 weeks, 3608 children were 28-32 weeks, 3553 children was 33-34 weeks, 1731 children was >34 weeks. The ocular findings were recorded according to the International Classification of ROP and The Early Treatment for ROP. Only the more aggressive eye of bilateral asymmetrical cases was counted for statistical purpose, and the cases required surgeries were defined as severe cases. The 10 years period was divided into first phase (2004-2008) and second phase (2009-2013). The incidence of ROP and severe ROP of these two phases was compared and statistics was analyzed. ResultsIn the past 10 years, the overall incidence of ROP and sever ROP in Shenzhen was 12.49% and 4.99% in this screen. The children were divided into 4 groups according to the birth weight, the ROP incidences of birth weight <1000 g, 1000-1499 g, 1500-1999 g and ≥2000 g were 62.62%, 28.40%, 11.34% and 3.63% respectively. The severe ROP incidences were 34.95%, 12.21%, 3.73% and 0.49% respectively in these birth weight groups. The children were divided into 4 groups according to gestational weeks, the ROP incidences of gestational age <28 weeks, 28-32 weeks, 33-34 weeks and >34 weeks were 67.31%, 25.27%, 7.22% and 3.87% respectively. Severe ROP incidences were 37.02%, 10.71%, 1.79% and 0.68% in these gestational age groups respectively. ROP and severe ROP incidences were decreased from 14.64% at first phase to 11.47% at second phase, and from 6.52% at first phase to 4.26% second phase respectively, the differences were statistical significant (χ2=26.96, 26.61; P<0.05). ROP and severe ROP incidence in <1000 g birth weight group at second phase were much less than the first phase (χ2=13.676, 5.271; P<0.05). In <28 weeks gestational age group, the ROP incidence was the same in first phase and second phase (χ2=0.843, P>0.05), but the severe ROP incidence at second phase was much less the first phase (χ2=4.757,P<0.05). ConclusionFrom 2004 to 2013, the incidences of ROP and severe ROP have decreased significantly in Shenzhen.
Retinopathy of prematurity (ROP) is the leading cause of blindness for children, early detection and treatment can prevent ROP progression and improve the visual prognosis. ROP prevention system, including advocacy, screening, diagnosis/treatment and follow-up, is the key to reducing the rate of blindness in children. The proposed tertiary ROP prevention network includes primary health centers in county-level, secondary health centers in municipal-level and tertiary health centers in provincial-level or national-level. The idea is to explore the greatest benefits in the ROP prevention process from the existing allocation of medical resources, but also to avoid wasting at the current stage of social development. We tested this idea in Shaanxi Province recently. The preliminary practice results indicated that ROP tertiary prevention network can increase the ROP screening coverage, promote the prevention and treatment of ROP. However this work is still in its infancy. We need to expand its scope and strength the advocacy efforts to find a way to prevent and treat ROP in China.
ObjectiveTo investigate the incidence and risk factors of retinopathy of prematurity (ROP) in extremely preterm infants (EPI) before 28 weeks of gestation during 8-years period.MethodsA retrospective study. From January 1, 2011 to December 31, 2018, 300 EPI infants with a gestational age of less than 28 weeks admitted to the neonatal intensive care unit (NICU) of Tianjin Central Hospital of Gynecology Obstetrics were included in the study. EPI birth gestational week (GA), birth weight (BW), gender and other basic information, as well as neonatal respiratory distress syndrome, oxygen (≥10 d), bronchopulmonary dysplasia (BPD) and other hospitalizations and complications were recorded. According to ROP international classification standards, ROP was staged. Severe ROP was defined as ROP that requires treatment. The screening start time, screening interval, and intervention time of all children tested were carried out in accordance with the requirements of the “Guidelines for Screening Retinopathy of Prematurity” until the end of follow-up. The most severe ROP during the follow-up of each examined child was recorded as the final screening result of the examined child, and those with asymmetric eyes with the screening results of the severe side of the diseas was recorded. A retrospective analysis of the overall incidence of EPI ROP showed the incidence of severe ROP, and the first and second stages of EPI ROP during the 8 years (from January 1, 2011 to December 31, 2014, and January 1, 2015 to December 31, 2018), changes in the rate of severe illness. Logistic regression analysis was used to screen independent risk factors for severe ROP.ResultsAmong 300 EPI infants, the average GA was (26.7±1.8) weeks; the average BW was (993.3±178.7) g. Two hundred and five infants (68.3%) were diagnosed with ROP, 116 (56.6%), 57 (27.8%), and 32 (15.6%) infants of stage Ⅰ, Ⅱ, and Ⅲ disease, respectively. There were no infants of stage IV and V. There were 30 infants (14.6%) with additional lesions and 59 infants (19.7%) with severe ROP requiring treatment. With the increase of GA (χ2=52.391, 44.521; P=0.000, 0.000) and BW (χ2=43.772, 26.138; P=0.000, 0.000), the incidence of EPI ROP and the incidence of severe ROP decreased significantly. From 2011 to 2018, the number of people surviving EPI obviously increased, especially those with small GA (26 weeks) and low BW (750 g). The average GA of the second stage EPI was lower than that of the first stage, the difference was statistically significant (t=2.243, P=0.026); the average BW of the second stage EPI was lower than the first stage, the difference was not statistically significant (t=1.428, P=0.154). The incidence of ROP in the second stage EPI was slightly higher than that in the first stage, and the incidence of severe ROP was lower than that in the first stage, the difference was not statistically significant (χ2=1.069, 1.723; P=0.301, 0.189). Multivariate logistic regression analysis showed that GA＜27 weeks (β=－2.584, P=0.032), maternal chorioamnionitis (CA) (β=－0.935, P=0.038) and BPD (β=－1.432, P=0.001) was an independent risk factor for severe ROP.ConclusionsThe incidence of EPI ROP and severe ROP are 68.3% and 19.7%, respectively. From 2011 to 2018, the number of survivors of EPI obviously increase, and those with small GA and low BW increase significantly; however, the incidence of ROP and severe ROP remaine stable. GA, CA and BPD are independent risk factors for severe ROP.