Incidence, risk factors and evolving treatment of severe retinopathy of prematurity in China: a retrospective multicenter cohort study in 70 neonatal intensive care units

Xuting Chen¹Yu Xu²Yanchen Wang^3,4Juan Du⁵Falin Xu⁶Xinyue Gu³Cao Yun³Jianhua Sun⁷Mingyan Hei⁵Shoo Kim Lee⁸HONGPING XIA^1*

• ¹Department of Neonatology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
• ²Shanghai Jiaotong University School of Medicine Xinhua Hospital, Shanghai, China
• ³Children's Hospital of Fudan University National Children's Medical Center, Shanghai, China
• ⁴McMaster University Department of Health Research Methods Evidence and Impact, Hamilton, Canada
• ⁵Beijing Children's Hospital Capital Medical University, Beijing, China
• ⁶The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
• ⁷Shanghai Children's Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
• ⁸Hopital Mont-Sinai, Montreal, Canada

Purpose: To investigate the current incidence, risk factors and treatment for severe retinopathy of prematurity (ROP) in very preterm infants in China. Methods: This was a descriptive, retrospective cohort study. The study population was very preterm infants admitted to one of the 70 neonatal intensive care units (NICUs) in the Chinese Neonatal Network who underwent ROP screening between January 2019 and December 2020. The primary outcome was severe ROP, defined as type 1 or type 2 ROP. Potential risk factors were identified based on prior evidence and statistical significance. Adjusted odds ratios with 95% confidence intervals were calculated using a multivariable multinomial logistic regression model. Results: This study included 14670 very preterm infants, among which 17.3% had low-grade ROP, and 8.5% had severe ROP. Treatment was performed in 1381 (4.7%) eyes of the infants, among which 1029 (74.5%), 148 (10.7%), and 124 (9.0%) received intravitreal anti-vascular endothelial growth factor injection only, laser treatment only, and vitreoretinal surgery, respectively. Extremely preterm birth (7.61, 95% CI: 6.12-9.46), small for gestational age (2.31, 95% CI: 1.71-3.12), outborn status (1.43, 95% CI: 1.22-1.67), 1-min Apgar score < 7 (1.30, 95% CI: 1.11-1.51), > 40 days on oxygen (1.70, 95% CI: 1.37-2.10), > 28 days on parenteral nutrition (1.17, 95% CI: 1-1.35), and any inotropes use (2.12, 95% CI: 1.82-2.46) were associated with increased odds of severe ROP. Antenatal steroid use (0.77, 95% CI: 0.66-0.91), large for gestational age (0.62, 95% CI: 0.45-0.85), and surfactant treatment (0.75, 95% CI: 0.64-0.87) were associated with reduced odds of severe ROP. Conclusion: The incidence of severe ROP in very preterm infants in China was high compared to the developed countries, and intravitreal anti-VEGF injection was the preferred treatment for severe ROP.