Screening for Retinopathy of Prematurity in Very Preterm Children: The EPIPAGE-2 Cohort Study

Neonatology. 2021;118(1):80-89. doi: 10.1159/000513225. Epub 2021 Feb 11.


Introduction: Retinopathy of prematurity (ROP) is a blinding disease that requires screening by retinal examination. Screening practices are rarely evaluated. We aimed to determine the prevalence of ROP screening in very preterm infants and individual- and center-related factors associated with ROP screening.

Methods: Data were extracted from the EPIPAGE-2 cohort, a French prospective population-based study of premature births in 2011. Children born before 32 weeks' gestation (WG) without severe malformation and alive at the recommended time for ROP screening were included. Outcome measures were achievement of ROP screening and compliance with recommended screening timeline. Individual- and center-related factors associated with both measures were studied using mixed models.

Results: Among 3,077 eligible infants, 2,169 (70.5%) had a ROP screening, ranging from 96% at 24 WG to 50% at 31 WG. Large variability among units was observed. Individual characteristics associated with screening were low gestational age, low birth weight, severe bronchopulmonary dysplasia or neurological lesions, and transfer between neonatal units during the screening period. Odds of screening were higher in neonatal units using wide-angle imaging (odds ratio 2.65 [95% confidence interval 1.17-6.01]) but decreased in units without a local protocol for ROP screening (0.03 [0.01-0.09]). Among screened children, 1,641/2,169 (75.7%) were screened according to recommended timeline. Delayed screening was associated with low gestational age, severe bronchopulmonary dysplasia or necrotizing enterocolitis, and absence of local protocol for ROP screening.

Discussion/conclusions: In this large cohort study of infants born very preterm, almost one-third were not screened for ROP. Children most at risk for ROP were the best screened but often with delay. The higher compliance of neonatal units using wide-angle imaging systems supports its use.

Keywords: Cohort study; Practice evaluation; Preterm neonate; Retinopathy of prematurity; Screening program.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Child
  • Cohort Studies
  • Female
  • Gestational Age
  • Humans
  • Infant
  • Infant, Extremely Premature
  • Infant, Newborn
  • Infant, Very Low Birth Weight
  • Pregnancy
  • Prospective Studies
  • Retinopathy of Prematurity* / diagnosis
  • Retinopathy of Prematurity* / epidemiology
  • Retrospective Studies
  • Risk Factors