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

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 14,670 very preterm infants, among which 17.3% had low-grade ROP, and 8.5% had severe ROP. Treatment was performed in 1,381 (4.7%) eyes of the infants, among which 1,029 (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 (SGA; 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 (PN; 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 (LGA; 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.