title: Retinopathy of prematurity in English neonatal units: a national population-based analysis using NHS operational data.
abstract: OBJECTIVE
  To report on retinopathy of prematurity (ROP) screening compliance against a national guideline, factors associated with non-compliance and effect on ROP treatment.
  
  
  METHODS
  National cohort study using operational NHS data from the National Neonatal Research Database (NNRD) for the period 2009-2011.
  
  
  METHODS
  161 (94%) neonatal units in England.
  
  
  METHODS
  Infants born below 32 weeks' gestation and/or with a birth weight below 1501 g.
  
  
  METHODS
  ROP screening status ('on-time', 'early', 'late', 'unknown') and associated infant and neonatal unit characteristics, ROP treatment.
  
  
  RESULTS
  The proportion of infants screened on-time increased over the study period (p<0.001). Of 19 821 eligible infants, 7602 (38.4%) were recorded to have received ROP screening in accordance with the national guideline; 7474 (37.8%) received screening outside the recommended time period; data were missing for 4745 (16.7%) infants. For 16 411 infants in neonatal care during the recommended screening period, late screening was significantly associated with lower gestational age (relative risk ratio (RRR) (95% credible interval) for late versus on-time screening 0.83 (0.80 to 0.86) for each increased week of gestation) and care in a neonatal unit providing less than 500 days of intensive care per annum (2.48 (0.99 to 4.99)). Infants screened late were almost 40% more likely to receive ROP treatment (OR (95% CI) 1.36 (1.05 to 1.76)).
  
  
  CONCLUSIONS
  Understanding organisational differences between neonatal units may help improve ROP screening. Patient-level electronic NHS clinical data offer opportunity for future rapid, low cost, population-based evaluations but require improved data entry.
authors.affiliation: Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, , London, UK.
authors.forename: Hilary S
authors.initials: HS
authors.lastname: Wong
authors.forename: Shalini
authors.initials: S
authors.lastname: Santhakumaran
authors.forename: Yevgeniy
authors.initials: Y
authors.lastname: Statnikov
authors.forename: Daniel
authors.initials: D
authors.lastname: Gray
authors.forename: Michael
authors.initials: M
authors.lastname: Watkinson
authors.forename: Neena
authors.initials: N
authors.lastname: Modi
mesh_terms: D001499:Bayes Theorem; D015331:Cohort Studies; D004739:England; D005260:Female; D005865:Gestational Age; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000628:therapy; D007363:Intensive Care Units, Neonatal / Q000458:organization & administration / Q000706:statistics & numerical data*; D008297:Male; D015997:Neonatal Screening / Q000592:standards*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012178:Retinopathy of Prematurity / Q000175:diagnosis* / Q000628:therapy; D013222:State Medicine; D013997:Time Factors
keywords: Electronic health records; Practice guidelines; Preterm infants; Retinopathy of prematurity; Vision screening