New developments in neonatology: less severe retinopathy of prematurity?
OBJECTIVE
To determine the effects of surfactant replacement therapy (SRT), high-frequency oscillatory ventilation (HFOV), and general improvements in quality of care on the incidence of severe retinopathy of prematurity (ROP).


METHODS
Retrospective comparison of the incidence and severity of ROP in two groups of preterm infants admitted to our neonatal intensive care unit (NICU) in two consecutive 5-year periods (1986-1995) and screened for ROP. During the second study period, natural surfactant was introduced in the treatment of respiratory distress syndrome (RDS) and HFOV was used for treatment of respiratory insufficiency of any origin. The effects of these developments and general improvements on the incidence of severe ROP were analyzed with stepwise logistic regression.


RESULTS
The overall incidence of ROP from 1986-1990 was not significantly different from the incidence of ROP from 1991-1995. The incidence of severe ROP (ROP stage 3 or greater) was significantly lower in the second period (15.7% versus 6.4%, P=.015). For infants <1000 g, the incidence of overall ROP was increased significantly during the second study period (47.6% versus 60.1 %, P=.045), although the incidence of severe ROP remained unchanged. Only SRT was associated with a decreased risk for severe ROP; HFOV and general improvements in quality of care had no influence on the outcome. In patients with RDS, the incidence of severe ROP decreased significantly during the second period.


CONCLUSIONS
Of the recent new developments in neonatology, only SRT was associated with a decreased risk for severe ROP.
Termote
J
J
Department of Neonatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Schalij-Delfos
N E
NE
Brouwers
H A
HA
Donders
A R
AR
Cats
B P
BP
D006612:High-Frequency Ventilation; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D009359:Neonatology / Q000639:trends*; D009426:Netherlands / Q000453:epidemiology; D011663:Pulmonary Surfactants / Q000627:therapeutic use; D011787:Quality of Health Care; D012178:Retinopathy of Prematurity / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
D011663:Pulmonary Surfactants