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Retinopathy of Prematurity in Infants Born Before 27 Weeks of Gestation: A National Population-based Study in Sweden During 2004-2007
Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
2010 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Background: Improved neonatal care has resulted in an increasing population of surviving infants. Neonatal morbidity in preterm infants is, however, high, and retinopathy of prematurity (ROP) is one of the major neonatal morbidities. Observations have suggested that ROP might have a different course in extremely preterm compared to more mature infants.

Aims: To study the incidence, natural history and treatment of the disease, and the implications regarding screening recommendations for the population of extremely preterm infants.

Methods: A national, population-based study of neonatal morbidity in infants born before 27 gestational weeks was performed in Sweden during 2004 to 2007. ROP screening started in the 5th postnatal week and continued until the retina was completely vascularized.

Results: Of the 506 infants surviving until the first ROP examination, 73% developed ROP; 38% mild ROP and 35% severe ROP. Ninety-nine infants (20%) were treated. A log-linear relationship was found between severe ROP and gestational age (GA) at birth, and the risk of ROP was reduced by 50% for each week of increase in GA at birth (Paper I).

Postmenstrual age (PMA) at onset of ROP was significantly related to GA at birth, as was the site of onset of ROP. ROP had a predilection to start in the nasal retina in the most immature infants. There were significant relations between PMA at onset of ROP and severity of ROP as well as between the site of onset of ROP and severe ROP (Paper III).

The most immature infants had a higher risk of reaching treatment criteria for ROP, a higher risk of progression from ROP 3 to treatment criteria, and they reached these criteria at an earlier PMA than the less immature infants (Paper II).

According to our results, the first examination can be postponed until a PMA of 31 weeks in infants born before 27 weeks of gestation, since onset of ROP 3 did not occur before this age, and criteria for treatment were not reached before 32 weeks. The majority of infants (75%) were treated during a limited period, i.e. before a PMA of 39 weeks (Paper IV).

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis , 2010.
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 566
Nyckelord [en]
Retinopathy of prematurity, extremely preterm, population-based, epidemiology, treatment, natural history, screening
Nationell ämneskategori
Oftalmologi
Forskningsämne
Oftalmiatrik; Pediatrik; Epidemiologi
Identifikatorer
URN: urn:nbn:se:uu:diva-122747ISBN: 978-91-554-7819-3 (tryckt)OAI: oai:DiVA.org:uu-122747DiVA, id: diva2:311390
Disputation
2010-06-12, Enghoffsalen, Ingång 50, Akademiska Sjukhuset, Uppsala, 09:15 (Norska)
Opponent
Handledare
Tillgänglig från: 2010-05-20 Skapad: 2010-04-19 Senast uppdaterad: 2022-01-28
Delarbeten
1. Incidence of retinopathy of prematurity in infants born before 27 weeks' gestation in Sweden
Öppna denna publikation i ny flik eller fönster >>Incidence of retinopathy of prematurity in infants born before 27 weeks' gestation in Sweden
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2009 (Engelska)Ingår i: Archives of ophthalmology (1960), ISSN 0003-9950, Vol. 127, nr 10, s. 1315-1319Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

OBJECTIVE: To determine the incidence of retinopathy of prematurity (ROP) in extremely preterm infants born before 27 weeks' gestation in Sweden during a 3-year period. METHODS: A national, prospective, population-based study was performed in Sweden from April 1, 2004, to March 31, 2007. The ophthalmologic part of the study was separately organized, and screening for ROP was performed beginning postnatal week 5. The criteria for the treatment of ROP agreed with the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. RESULTS: During the study, 506 of 707 live-born infants survived until the first eye examination. Of these, 368 (72.7%) had ROP: 37.9% had mild ROP and 34.8% had severe ROP. Ninety-nine infants (19.6%) were treated. Gestational age at birth was a stronger predictor of ROP than was birth weight. A log-linear relationship between severe ROP and gestational age at birth was found in the present cohort, and the risk of ROP was reduced by 50% for each week of increase in gestational age at birth. CONCLUSIONS: Today, extremely preterm infants are surviving, and this population-based study with ROP as a primary outcome shows a higher incidence of this condition than in previously reported national cohorts.

Nationell ämneskategori
Medicin och hälsovetenskap
Identifikatorer
urn:nbn:se:uu:diva-121732 (URN)10.1001/archophthalmol.2009.244 (DOI)000287329500008 ()19822848 (PubMedID)
Tillgänglig från: 2010-03-29 Skapad: 2010-03-29 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
2. Treatment for retinopathy of prematurity in infants born before 27 weeks of gestation in Sweden
Öppna denna publikation i ny flik eller fönster >>Treatment for retinopathy of prematurity in infants born before 27 weeks of gestation in Sweden
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2010 (Engelska)Ingår i: British Journal of Ophthalmology, ISSN 0007-1161, E-ISSN 1468-2079, Vol. 94, nr 9, s. 1136-1139Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

AIMS: To study various aspects of treatment for retinopathy of prematurity (ROP) in a Swedish population of extremely preterm infants born before 27 weeks of gestation. METHODS: A national, prospective and population-based study was performed in Sweden from April 1, 2004 to March 31, 2007. The criteria for treatment of ROP accorded with the recommendations of the Early Treatment for Retinopathy of Prematurity Cooperative Group. RESULTS: Twenty percent of the infants (99/506) were treated for ROP. The likelihood of reaching treatment criteria nearly doubled for each week of reduction in gestational age (GA) at birth. The first treatment was performed at an earlier postmenstrual age in the most immature infants. One third of the infants had more than one session of laser treatment. CONCLUSIONS: A high percentage of these extremely preterm infants required treatment for ROP. The likelihood of reaching treatment criteria increased with a decline in GA at birth. Although only a few infants progressed to ROP Stages 4 and 5, our findings indicate a potential for improvement of the treatment routines, both regarding timing and number of laser spots at the first treatment.

Nyckelord
Retinopathy of prematurity, extremely preterm, population-based, treatment
Nationell ämneskategori
Oftalmologi
Forskningsämne
Oftalmiatrik; Pediatrik
Identifikatorer
urn:nbn:se:uu:diva-121731 (URN)10.1136/bjo.2009.170704 (DOI)000282206500006 ()19951941 (PubMedID)
Tillgänglig från: 2010-03-29 Skapad: 2010-03-29 Senast uppdaterad: 2022-01-28Bibliografiskt granskad
3. Natural history of retinopathy of prematurity in infants born before 27 weeks' gestation in Sweden
Öppna denna publikation i ny flik eller fönster >>Natural history of retinopathy of prematurity in infants born before 27 weeks' gestation in Sweden
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2010 (Engelska)Ingår i: Archives of ophthalmology (1960), ISSN 0003-9950, Vol. 128, nr 10, s. 1289-1294Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Objective: To investigate the natural history of retinopathy of prematurity (ROP) in 506 extremely preterm infants born before 27 weeks' gestation in Sweden during a 3-year period.

Methods: A national population–based study was performed in Sweden from April 1, 2004, to March 31, 2007. According to the study protocol, initial eye examinations were to be performed at postnatal week 5, and examinations were repeated until the retina was completely vascularized or until criteria for treatment were met. The examinations were to be performed weekly, enabling study of the course and severity of ROP. In infants without ROP or with mild ROP without progression during the latest examinations, further examinations were performed weekly or every other week from postmenstrual age 35 weeks.

Results: During the study, 368 infants (72.7%) developed ROP. Postmenstrual age at onset of ROP was significantly related to severity of ROP, even when controlling for gestational age (ie, the earlier the onset of ROP, the higher the risk of developing severe ROP). Site of onset of ROP was significantly related to gestational age at birth. The risk of nasal onset was almost doubled for every week of decrease in gestational age at birth. Nasal onset was associated with severe ROP, even after adjusting for gestational age at birth.

Conclusion: This population-based study confirms results of the Cryotherapy for Retinopathy of Prematurity study and shows new correlations regarding time and site of onset of ROP, both of which are associated with disease severity.

Ort, förlag, år, upplaga, sidor
American Medical Association, 2010
Nyckelord
Retinopathy of prematurity, extremely preterm, population-based, natural history
Nationell ämneskategori
Oftalmologi
Forskningsämne
Oftalmiatrik
Identifikatorer
urn:nbn:se:uu:diva-122983 (URN)10.1001/archophthalmol.2010.234 (DOI)000282844000007 ()
Tillgänglig från: 2010-04-22 Skapad: 2010-04-22 Senast uppdaterad: 2022-01-28Bibliografiskt granskad
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