Incidence, Risk Factors and Screening Evaluation of Retinopathy of Prematurity in High Birthweight Infants: A Large Cohort Study in Turkey

ABSTRACT

Purpose

To report and evaluate the incidence and risk factors of retinopathy of prematurity (ROP) and to assess the sensitivity and specificity of Turkish national screening guideline (NSG) in heavier infants with a birth weight (BW) of >1500 g.

Methods

The data of 1784 preterm infants with BW>1500 g, who were screened between 2009 and 2016 in a university hospital in Turkey, were analyzed retrospectively. The rates of any stage and severe (treatment-requiring) ROP incidence were investigated. The possible protective and risk factors were evaluated with univariate analyses and logistic regression analysis.

Results

The rate of any stage ROP was 14.1% (n = 251). Severe ROP was observed in 11 infants (0.6%), and 2 of the infants (0.1%) had a gestational age (GA)>32 weeks, which fell outside of the NSG. In logistic regression analysis, BW, GA, O₂ therapy duration, and exchange transfusion were determined to be independent risk factors (respectively, p < .001, p < .001, P = .055, and P = .033). Furthermore, antenatal steroid therapy was determined to have a highly significant protective effect on ROP development (p < .001). The sensitivity of Turkish NSG in identifying severe ROP increased from 82% to 100% with the inclusion of risk factors in addition to GA and BW.

Conclusion

This study shows the presence of severe ROP in mature and heavy infants in Turkey. The positive effect of antenatal steroid use and the negative impact of exchange transfusion have been demonstrated for ROP development in mature infants. Possible risk factors should be evaluated with GA and BW to avoid missing severe ROP.

KEYWORDS:

• Retinopathy of prematurity
• screening
• sensitivity and specificity
• heavy infants
• mature infants
• risk factors
• antenatal steroid
• exchange transfusion

Disclosure statement

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest.

Author contributions

All authors conceived and designed the study. HÇ, VD, and SB acquired the data. VD and SB analyzed and interpreted the data. VD wrote the manuscript. HÇ and ÖŞ revised the final manuscript.

Availability of data and material

Raw data were generated at Marmara University School of Medicine Ophthalmology Department. Derived data that support the findings of this study are available from the corresponding author (VD) on request.

Consent to participate

Consent and approval were obtained from Institutional Ethics Committee of Marmara University (Istanbul, Turkey) for processing the data of patients’ records in this retrospective study.

Ethical approval

All procedures in studies that involve human participants were performed in accordance with the ethical standards of the Institutional Ethics Committee of Marmara University (Istanbul, Turkey) and the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Funding

This study was not funded.