title: No advanced retinopathy of prematurity stages 4 or 5 in a large high-risk German cohort.
abstract: BACKGROUND
  Retinopathy of prematurity (ROP) remains a major cause of juvenile blindness. As screening recommendations are refined, decreasing gestational age (GA) and birth weight (BW) constitute an increasing risk for ROP. This retrospective case series reviews the screening results of a very immature cohort in Germany.
  
  
  METHODS
  We conducted ROP screening according to the German guidelines of 1999: all preterm infants with a GA of < 32 weeks and/or a BW of < 1501 g, or with GA ≥ 32 weeks and postnatal oxygen treatment for > 3 days, were assigned for screening. Dense laser coagulation was performed according to the current treatment criteria.
  
  
  RESULTS
  All 767 consecutive inborn (patients born at the Department of Neonatology, University Hospital of Cologne, Germany) preterm infants of a tertiary medical centre of maximum care underwent complete screening from 2001 to 2009. The treatment incidence was 7.0%. No preterm infant developed stage 4/5 ROP. Mean GA and BW of untreated/treated preterm infants were 28.4/24.6 weeks and 1109/635 g, respectively. Increasing treatment incidence was associated with lower GA, but not with lower BW in logistic regression analysis.
  
  
  CONCLUSIONS
  In this very immature high-risk cohort, advanced stages 4 and 5 were avoided throughout 9 years of screening. We suggest three factors that contributed to this outcome: (1) strict adherence to current ROP screening and treatment guidelines; (2) prompt and very dense laser coagulation if necessary; and (3) a specialised neonatal intensive care unit with experience of very immature babies.
authors: Department of Vitreoretinal Surgery, Center of Ophthalmology, University of Cologne, Kerpener Strasse 62, 50924 Cologne, Germany. philmuether@mac.com
authors: Philipp S
authors: PS
authors: Muether
authors: Angela
authors: A
authors: Kribs
authors: Moritz
authors: M
authors: Hahn
authors: Jasmin
authors: J
authors: Schumacher
authors: Frank
authors: F
authors: Eifinger
authors: Bernd
authors: B
authors: Kirchhof
authors: Bernhard
authors: B
authors: Roth
authors: Sascha
authors: S
authors: Fauser
mesh_terms: D001724:Birth Weight; D005260:Female; D005858:Germany; D005865:Gestational Age; D019983:Guideline Adherence; D006801:Humans; D007231:Infant, Newborn; D019102:Infant, Very Low Birth Weight; D017075:Laser Coagulation; D008297:Male; D008403:Mass Screening; D010102:Oxygen Inhalation Therapy; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy; D012178:Retinopathy of Prematurity / Q000145:classification / Q000517:prevention & control* / Q000601:surgery; D012189:Retrospective Studies