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Am J Perinatol 2022; 29(14): 1569-1576
DOI: 10.1055/s-0041-1723830
Original Article

The U.S. National Trend for Retinopathy of Prematurity

Hany Aly 
1   Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
,
Hasan F. Othman
2   Department of Pediatrics, Michigan State University/Sparrow Health System, Lansing, Michigan
,
Chelsea Munster
1   Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
,
Anirudha Das
1   Department of Neonatology, Cleveland Clinic Children's, Cleveland, Ohio
,
Jonathan Sears
3   Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio
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Abstract

Objective The use of supplemental oxygen in premature infants is essential for survival. However, its use has been associated with unintended complications. The restricted use of oxygen is associated with increased mortality and necrotizing enterocolitis (NEC), whereas its liberal use is associated with increased risk for retinopathy of prematurity (ROP). Although there is no clear consensus on the acceptable oxygen saturation range, clinicians have recently become more liberal with the use of oxygen. We aim to assess (1) the national trends for ROP in very low birth weight preterm infants, and (2) the associated trends in mortality, NEC, intraventricular hemorrhage (IVH), and length of hospital stay (LOS).

Study Design We analyzed deidentified patient data from the National Inpatient Sample (NIS) of the Healthcare Cost and Utilization Project (HCUP) from 2002 to 2017. All infants with gestational age ≤32 weeks and birth weight <1,500 g were included. Trends in ROP, severe ROP, mortality, NEC, IVH, severe IVH, and LOS were analyzed using Jonckheere–Terpstra test.

Results A total of 818,945 neonates were included in the study. The overall mortality was 16.2% and the prevalence of ROP was 17.5%. There was a significant trend for increased ROP over the years (p < 0.001). Severe ROP was also significantly increased (p < 0.001). This was associated with a significant trend for increased median LOS in survived infants (p < 0.001). Mortality was significantly decreased (p < 0.001), whereas NEC and severe NEC did not change over time (p = 0.222 and p = 0.412, respectively).

Conclusion There is a national trend for increased ROP and severe ROP over the 16 years of the study period. This trend was associated with a significant increase in the LOS in survived infants without change in NEC.

Key Points

  • Prevalence of ROP and severe ROP has increased in VLBW infants over the 16-year study period.

  • The prevalence of NEC did not change over the same time period.

  • Increased ROP and severe ROP were consistent in all three GA and BW subgroups.

Keywords

ROP - premature infants - targeted oxygen saturation

Authors' Contributions

H.A. conceptualized and designed the study and critically reviewed the manuscript for important intellectual content. H.F.O. performed the analyses. C.M. drafted the initial manuscript. A.D., J.S., and H.F.O. reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


Supplementary Material



Publication History

Received: 01 July 2019

Accepted: 05 January 2021

Article published online:
16 February 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Alajbegovic-Halimic J, Zvizdic D, Alimanovic-Halilovic E, Dodik I, Duvnjak S. Risk factors for retinopathy of prematurity in premature born children. Med Arch 2015;69(06):
    PubMed
  • 2 Bashinsky AL. Retinopathy of prematurity. N C Med J 2017; 78 (02) 124-128
    PubMedSearch in Google Scholar
  • 3 Yau GSK, Lee JWY, Tam VTY. et al. Incidence and risk factors for retinopathy of prematurity in multiple gestations: a Chinese population study. Medicine (Baltimore) 2015; 94 (18) e867
    CrossrefPubMedSearch in Google Scholar
  • 4 Carlo WA, Finer NN, Walsh MC. et al; SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network. Target ranges of oxygen saturation in extremely preterm infants. N Engl J Med 2010; 362 (21) 1959-1969
    CrossrefPubMedSearch in Google Scholar
  • 5 Shukla A, Sonnie C, Worley S. et al. Comparison of biphasic vs static oxygen saturation targets among infants with retinopathy of prematurity. JAMA Ophthalmol 2019; 137 (04) 417-423
    CrossrefPubMedSearch in Google Scholar
  • 6 Baba T, Grebe R, Hasegawa T. et al. Maturation of the fetal human choriocapillaris. Invest Ophthalmol Vis Sci 2009; 50 (07) 3503-3511
    CrossrefPubMedSearch in Google Scholar
  • 7 Alon T, Hemo I, Itin A, Pe'er J, Stone J, Keshet E. Vascular endothelial growth factor acts as a survival factor for newly formed retinal vessels and has implications for retinopathy of prematurity. Nat Med 1995; 1 (10) 1024-1028
    CrossrefPubMedSearch in Google Scholar
  • 8 Kennedy KA, Wrage LA, Higgins RD. et al; SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Evaluating retinopathy of prematurity screening guidelines for 24- to 27-week gestational age infants. J Perinatol 2014; 34 (04) 311-318
    CrossrefPubMedSearch in Google Scholar
  • 9 Semenza GL, Nejfelt MK, Chi SM, Antonarakis SE. Hypoxia-inducible nuclear factors bind to an enhancer element located 3′ to the human erythropoietin gene. Proc Natl Acad Sci U S A 1991; 88 (13) 5680-5684
    CrossrefPubMedSearch in Google Scholar
  • 10 Ozaki H, Yu AY, Della N. et al. Hypoxia inducible factor-1alpha is increased in ischemic retina: temporal and spatial correlation with VEGF expression. Invest Ophthalmol Vis Sci 1999; 40 (01) 182-189
    PubMedSearch in Google Scholar
  • 11 Aiello LP, Avery RL, Arrigg PG. et al. Vascular endothelial growth factor in ocular fluid of patients with diabetic retinopathy and other retinal disorders. N Engl J Med 1994; 331 (22) 1480-1487
    CrossrefPubMedSearch in Google Scholar
  • 12 Pierce EA, Foley ED, Smith LE. Regulation of vascular endothelial growth factor by oxygen in a model of retinopathy of prematurity. Arch Ophthalmol 1996; 114 (10) 1219-1228
    CrossrefPubMedSearch in Google Scholar
  • 13 Quinn GE. Retinopathy of prematurity blindness worldwide: phenotypes in the third epidemic. Eye Brain 2016; 8: 31-36
    CrossrefPubMedSearch in Google Scholar
  • 14 Shah PK, Prabhu V, Karandikar SS, Ranjan R, Narendran V, Kalpana N. Retinopathy of prematurity: past, present and future. World J Clin Pediatr 2016; 5 (01) 35-46
    CrossrefPubMedSearch in Google Scholar
  • 15 Mantagos IS, VanderVeen DK, Smith LEH. Risk factors for retinopathy of prematurity: beyond age, birth weight, and oxygen. Curr Ophthalmol Rep 2013; 1 (04) 213-217
    CrossrefPubMedSearch in Google Scholar
  • 16 Hwang JH, Lee EH, Kim EA-R. Retinopathy of prematurity among very-low-birth-weight infants in Korea: incidence, treatment, and risk factors. J Korean Med Sci 2015; 30 (Suppl. 01) S88-S94
    CrossrefPubMedSearch in Google Scholar
  • 17 Volpe JJ. Intraventricular hemorrhage in the premature infant--current concepts. Part I. Ann Neurol 1989; 25 (01) 3-11
    CrossrefPubMedSearch in Google Scholar
  • 18 Askie LM, Darlow BA, Finer N. et al; Neonatal Oxygenation Prospective Meta-analysis (NeOProM) Collaboration. Neonatal Oxygenation Prospective Meta-analysis (NeOProM) Collaboration. Association between oxygen saturation targeting and death or disability in extremely preterm infants in the neonatal oxygenation prospective meta-analysis collaboration. JAMA 2018; 319 (21) 2190-2201
    CrossrefPubMedSearch in Google Scholar
  • 19 Hamilton BE, Martin JA, Osterman MJK, Curtin SC, Matthews TJ. Births: final data for 2014. Natl Vital Stat Rep 2015; 64 (12) 1-64
    PubMedSearch in Google Scholar
  • 20 Perrone S, Bracciali C, Virgilio ND, Buonocore G. Oxygen use in neonatal care: a two-edged sword. Front Pediatr 2016;•••
    PubMed
  • 21 Herrmann K, Carroll K. An exclusively human milk diet reduces necrotizing enterocolitis. Breastfeed Med 2014; 9 (04) 184-190
    CrossrefPubMedSearch in Google Scholar