Author: Marko Popovic (Canada)
Co-authors: Caberry Yu, Arjan Dhoot, Parnian Arjmand, Rajeev Muni, Kamiar Mireskandari, Peter Kertes
Purpose
Current national retinopathy of prematurity (ROP) guidelines use gestational age (GA) and birth weight (BW) as the basis for screening. The epidemiology of infants with ROP is evolving, and an evaluation of risk factors is necessary to facilitate early diagnosis and treatment. This systematic review was conducted to analyze the association between demographic risk factors and the incidence of ROP in regional population-based studies to inform screening guidelines.
Setting/Venue
Systematic review of population-based studies.
Methods
The review was conducted according to PRISMA guidelines (PROSPERO CRD42020185343). Ovid MEDLINE, EMBASE, and Cochrane Library were searched from January 2010 through May 2020. Original studies investigating the incidence of ROP in a region and cohort demographic risk factors were included. Risk of bias was assessed using a validated tool for prevalence studies. Quality of evidence was assessed using the GRADE methodology. A weighted mean was used for pooling of continuous outcomes. ROP incidence was reported in proportions and compared based on cohort demographics and criteria for screening guidelines.
Results
From 4091 results, 18 studies (n=20,701,040) were included. The risk of bias across studies was low, and the certainty of evidence was moderate for most outcomes. The overall incidence of ROP across all studies was 0.15%. Overall, ROP stages ≥3 accounted for 20.5% of ROP cases. The mean GA and BW for infants with any ROP ranged from 26.5 to 28.5 weeks and 723 to 950 grams, respectively. The weighted incidence of any, severe, and treatment-requiring ROP was highest at 23 weeks GA (66.5%, 40.3%, and 39.4% respectively). For every week decrease in GA, there was a median adjusted odds ratio (aOR) of 1.4 times of developing ROP. For every 100 gram decrease in BW, the median aOR was 1.8 times. A higher incidence of ROP was also found for infants with neonatal sepsis (n=3 studies, median OR=2.02) and bronchopulmonary dysplasia (n=2, median OR=7.57). The review was limited by inter-study heterogeneity secondary to geographic location and methodology.
Conlusions
The overall incidence of ROP among live births was 0.15%. The incidence increased proportionally with lower GA and BW, with a diagnosis of ROP occurring in 2 of 3 infants born at GA 23 weeks and 1 of 3 infants born at BW ≤1000 grams. The strongest risk factors for ROP are GA, BW, neonatal sepsis and bronchopulmonary dysplasia. Based on demographic risk factors, national ROP screening guidelines should focus efforts on screening infants at risk and optimizing examination schedules. Future studies should continue to investigate risk factors for ROP and examine if current screening guidelines can be optimized based on the latest evidence.
Financial Disclosure
MMP: Financial support (to institution) – PSI Foundation. PJK: Advisory board – Novartis, Allergan, Bayer, Roche, Novelty Nobility; Financial support (to institution) – Allergan, Novartis, Bayer, Roche; Financial support – Novartis, Bayer, Zeiss; Equity owner – ArcticDx. RHM: Advisory board- Bayer, Novartis, Allergan, Roche; Financial Support (to institution)- Bayer, Novartis. KM: Advisory board – Santen Inc; Non-Financial Support – Bayer.
Comments
-