Severe retinopathy of prematurity and its association with different rates of survival in infants of less than 1251 g birth weight
J Vyasa, D Fielda, E S Drapera, G Woodruffa, A R Fielderb, J Thompsona, N J Shawc, D Clarkc, R Gregsond, J Burkee, G Durbinf
a Departments of Child
Health, Epidemiology and Ophthalmology, University of Leicester,
Leicester, UK, b Imperial
College School of Medicine, London, c Liverpool Women's Hospital, Liverpool, UK, d Queens
Medical Centre, Nottingham, UK, e Central Sheffield University Hospitals NHS
Trust, Sheffield, UK, f Birmingham
Maternity Hospital, Birmingham, UK
Correspondence to: Professor D Field, Department of Child Health, Robert Kilpatrick Clinical Sciences Building, University of Leicester, Leicester LE2 7LX, UK
Accepted 24
September 1999
BACKGROUND
There is
controversy over whether improved survival of preterm infants has
resulted in a higher incidence of severe (grade 3 or greater)
retinopathy of prematurity (ROP).
AIMTo compare
survival rates and rates of 
stage 3 ROPthat is, with a high risk
of sequelaein preterm infants in five English cities where,
anecdotally, the incidence of ROP is reported to show considerable variation.
METHODSAll infants of
birth weight < 1500 g and or gestational age < 32 weeks, born in
1994 in one of the cities or transferred in within 48 hours, were
studied. The populations were adjusted for case mix variation using
CRIB (clinical risk index for babies, a disease severity scoring
system). The incidence of severe ROP, the actual death rate, and that
adjusted for disease severity were determined.
RESULTSThe rate of
severe ROP per 1000 births was higher in city 1 than in all the other
cities. This increase in comparison with city 2 and city 4 was
significant (city 1, 167 (95% confidence interval (CI) 96 to 260);
city 2, 24 (6 to 59); city 4, 16 (1 to 84)). A significant difference
was not seen between city 1 and cities 3 (23 (1 to 120)) and 5 (74 (21 to 79)). The relative risk of developing severe ROP in city 1 compared
with all the other cities was 5.5 (2.5 to 11.9). The actual death rate
per 1000 births in city 1 was significantly lower than that predicted by modelling death against CRIB score (city 1: actual 270; predicted 385 (95% CI 339 to 431)). In contrast, the other cities had actual death rates as predicted, or worse than predicted, by CRIB.
INTERPRETATIONA
significantly higher incidence of severe ROP was identified in one of
the five cities studied. Variation in survival rates among high risk
infants may explain this observation.
Keywords: eye; retinopathy of prematurity; very preterm infants; survival rates; oxygen treatment
© 2000 by Archives of Disease in Childhood
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