Surveillance for retinopathy of prematurity in a Copenhagen high-risk sample 1999-2001. Has progress reached a plateau?

Purpose: As part of current quality control to evaluate ophthalmic findings in the two combined central Copenhagen neonatology centres, for birth years 1999-2001, and to compare the selected sample with data of the national register for childhood visual impairment. Methods: In a prospective design to report on 372 infants mainly under regular surveillance for retinopathy of prematurity (ROP) in the stratified functional unit made up by the neonatal wards of Rigshospitalet (RH) and Hvidovre Hospital (HH). The median neonate under ophthalmic surveillance in the two wards (screening limits usually 32weeks/1750g) was given by gestational age (GA) and birth-weight (BW) values of 27.3 weeks/907g and 30.3 weeks/1420g, respectively. Feedback regarding outcome was secured for those transferred to regional centres. Results: The overall frequency of ROP was 38.5% in the RH (n = 252) and 10.8% in the HH sample (n = 120). From a peak share above 60% in those < 26 weeks/750g at delivery, the incidence of ROP showed a regular decrease with decreasing immaturity. The centralized retinal ablation therapy for advanced ROP was given to a total of 29, with birth year 2001 unexpectedly showing a peak of 17 cases. Seven of the 29 children treated are now in the register for visually impaired, mainly due to low vision. Fourteen of the 29 had been very small for gestational age. Conclusions: Supported also by recent regional Danish data, the apparent progress in the fight against ROP over many years seems to have come to a halt. Except for the continued increased survival of extremely preterm babies we have no obvious neonatological indications to explain the suggested 'adverse' trend.