Clinical and Demographic Characteristics of Treatment Requiring Retinopathy of Prematurity (ROP) in Big Premature Infants in Turkey - Report No: 1 (BIG-ROP STUDY)

AimTo demonstrate the clinical and demographic features of infants with gestational age (GA) of 32-37 weeks (wk) and birth weight (BW) of >1500 g who developed treatment requiring retinopathy of prematurity (ROP). MethodsRetrospective, observational, descriptive, multicentre study was conducted by the Turkish Ophthalmological Association ROP commission. Data on the infants with a GA of 32-37 wk and BW >1500 g who developed treatment-requiring ROP were collected from the 33 ROP centres in Turkey. GA, BW, type of hospital, neonatal intensive care units (NICU) level, length of stay in NICU, duration of oxygen therapy, comorbidities, type of ROP and time for treatment-requiring ROP (TR-ROP) development were analysed. ResultsTotally 366 infants were included in the study. The mean GA and BW were 33{+/-}1 wk and 1896 {+/-} 316 g, respectively. Duration of hospitalization was 3-4 wk in 46.8% of them. The first ROP examination was performed at postnatal 4-5 wk in 80.3% of infants, which was significantly later in lower levels of NICU and non-university clinics. ROP was detected in 90.9% of infants at the first ROP examination, especially in clinics without an ophthalmologist. In 15.3% of the infants, treatment was required in postnatal fourth week, and the mean development of TR-ROP was 6.16 {+/-} 2.04 wk ConclusionRoutine ROP screening thresholds need to be expanded in hospitals with suboptimal NICU conditions considering the development of TR-ROP in more mature and heavier preterm infants, and the first ROP examination should be no later than postnatal fourth week. What is already known on this topicTreatment-requiring retinopathy of prematurity (TR-ROP) may develop in bigger and more mature infants with a gestational age >32 weeks and birth weight >1500g especially in low/middle-income countries where proper neonatal intensive care conditions could not be provided, What this study addsThis is the first study analysing the regional differences and the effect of presence of the ophthalmologist and neonatologist in the same hospital as NICU on the development of TR-ROP in a nation-wide study in Turkey. This study emphasizes the high rate of ROP at the first examination in these bigger babies and progression to TR-ROP in a short time. The ROP in these infants may be more aggressive like A-ROP and may progress rapidly in a short time. The results of our study suggest the need for a timely (even earlier) screening for bigger infants and a revision to expand the limits of the ROP screening program to bigger infants in at least underdeveloped parts of Turkey. This may be generalized to all of the underdeveloped countries. How this study might affect research, practice or policyScreening criteria for ROP need to be revised for the coverage of bigger infants in Turkey depending on the NICU conditions of the hospitals. Infants with a gestational age of >32 weeks and a birth weight of >1500 g may need to be screened for ROP earlier than postnatal four weeks. Increasing the number of well-educated neonatologists and ophthalmologists as well as other NICU conditions will improve neonatal care for ROP to the standards of developed countries.