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Retinopathy of prematurity in English neonatal units: a national population-based analysis using NHS operational data
  1. Hilary S Wong1,
  2. Shalini Santhakumaran1,
  3. Yevgeniy Statnikov1,2,
  4. Daniel Gray1,2,
  5. Michael Watkinson2,
  6. Neena Modi1,2,
  7. and the UK Neonatal Collaborative
  1. 1Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, London, UK
  2. 2National Neonatal Audit Programme, Royal College of Paediatrics and Child Health, UK
  1. Correspondence to Professor Neena Modi, Section of Neonatal Medicine, Department of Medicine, Imperial College London, Chelsea & Westminster Hospital campus, 369 Fulham Road, London SW10 9NH, UK; n.modi{at}


Objectives To report on retinopathy of prematurity (ROP) screening compliance against a national guideline, factors associated with non-compliance and effect on ROP treatment.

Design National cohort study using operational NHS data from the National Neonatal Research Database (NNRD) for the period 2009–2011.

Setting 161 (94%) neonatal units in England.

Population Infants born below 32 weeks’ gestation and/or with a birth weight below 1501 g.

Main outcome measures 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.

  • Retinopathy of prematurity
  • Preterm infants
  • Vision screening
  • Electronic health records
  • Practice guidelines

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