Retinopathy of prematurity: Eight-year outcomes of a Portuguese neonatal intensive care unit


  • Ricardo Liz Almeida Department of Neonatology, Maternidade Dr. Daniel de Matos, Centro Hospitalar Universitário de Coimbra; Department of Pediatrics, Centro Hospitalar Tondela-Viseu
  • Raquel Monteiro Costa Department of Pediatrics, Centro Hospitalar Tondela-Viseu
  • Monica Bennett Department of Pediatrics, Centro Hospitalar Baixo-Vouga
  • Mário Alfaiate Department of Ophthalmology, Centro Hospitalar Universitário de Coimbra
  • Lígia Basto Department of Neonatology, Maternidade Dr. Daniel de Matos, Centro Hospitalar Universitário de Coimbra



intensive care unit, neonatal, Portugal, retinopathy of prematurity, risk, screening


Introduction: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the retina in preterm newborns and is an important and preventable cause of visual impairment in children. The aim of this study was to investigate the incidence of ROP in a sample of preterm infants with ophthalmologic observation criteria and its association with specific major risk factors.
Methods: Retrospective study of clinical records of premature infants with criteria for ROP screening in a Portuguese neonatal intensive care unit between January 2011 and December 2018.
Results: Three hundred thirty-five infants met the criteria for ROP screening. The incidence of ROP and severe ROP requiring treatment was 9.0% and 1.8%, respectively. No infants with gestational age (GA) > 30 weeks or birth weight (BW) > 1500 g developed ROP. Neonatal comorbidities such as respiratory distress syndrome and intraventricular hemorrhage were not significantly associated with the development of ROP. GA, BW, supplemental oxygen therapy, and surfactant administration were independent predictors for the development of ROP.
Discussion: Compared to neighboring countries with similar human development indexes, the incidence of ROP found in this study was relatively low. Implementation of the American Academy of Pediatrics/American Academy of Ophthalmology (AAO/AAP) guidelines in daily practice would potentially reduce the number of infants screened and allow diagnosis of most ROP cases.
Conclusion: Statistically significant risk factors should be considered when evaluating preterm infants. Modification of current screening guidelines may be useful and cost-effective, and result in less stressful experiences for infants undergoing unnecessary ophthalmologic examinations.


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Blencowe H, Lawn JE, Vazquez T, Fielder A, Gilbert C. Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010. Pediatr Res 2013;74 Suppl 1:35-49.

Palmer EA, Flynn JT, Hardy RJ, et al. Incidence and early course of retinopathy of prematurity. The Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology 1991;98:1628-40.

Darlow BA, Gilbert C. Retinopathy of prematurity - A world update. Seminars in perinatology 2019;43:315-6.

Fielder A, Blencowe H, O’Connor A, Gilbert C. Impact of retinopathy of prematurity on ocular structures and visual functions. Archives of disease in childhood Fetal and neonatal edition 2015;100:F179-84.

Gilbert C. Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. Early human development 2008;84:77-82.

Kong L, Fry M, Al-Samarraie M, Gilbert C, Steinkuller PG. An update on progress and the changing epidemiology of causes of childhood blindness worldwide. Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus 2012;16:501-7.

Aiello LP, Pierce EA, Foley ED, et al. Suppression of retinal neovascularization in vivo by inhibition of vascular endothelial growth factor (VEGF) using soluble VEGF-receptor chimeric proteins. Proceedings of the National Academy of Sciences 1995;92:10457-61.

Kim SJ, Port AD, Swan R, Campbell JP, Chan RVP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Survey of Ophthalmology 2018;63:618-37.

Hellström A, Smith LEH, Dammann O. Retinopathy of prematurity. The Lancet 2013;382:1445-57.

Higgins RD. Oxygen Saturation and Retinopathy of Prematurity. Clinics in perinatology 2019;46:593-9.

Hartnett ME, Penn JS. Mechanisms and management of retinopathy of prematurity. The New England journal of medicine 2012;367:2515-26.

Ying GS, Quinn GE, Wade KC, Repka MX, Baumritter A, Daniel E. Predictors for the development of referral-warranted retinopathy of prematurity in the telemedicine approaches to evaluating acute-phase retinopathy of prematurity (e-ROP) study. JAMA ophthalmology 2015;133:304-11.

Rush R, Rush S, Nicolau J, Chapman K, Naqvi M. Systemic manifestations in response to mydriasis and physical examination during screening for retinopathy of prematurity. Retina (Philadelphia, Pa) 2004;24:242-5.

Mitchell AJ, Green A, Jeffs DA, Roberson PK. Physiologic effects of retinopathy of prematurity screening examinations. Advances in neonatal care : official journal of the National Association of Neonatal Nurses 2011;11:291-7.

Henriques G, Brito C, Clemente F, Breda J, Teixeira S. Retinopatia da prematuridade. Consensos Nacionais em Neonatologia Lisboa: Secção de Neonatologia, Sociedade Portuguesa de Pediatria 2016.

The International Classification of Retinopathy of Prematurity revisited. Archives of ophthalmology (Chicago, Ill : 1960) 2005;123:991-9.

Sweet DG, Carnielli V, Greisen G, et al. European Consensus Guidelines on the Management of Respiratory Distress Syndrome - 2016 Update. Neonatology 2017;111:107-25.

Martín Begué N, Perapoch López J. [Retinopathy of prematurity: incidence, severity and outcome]. Anales de pediatria (Barcelona, Spain : 2003) 2003;58:156-61.

Hernández M, Orduña C, Bosch V, Salinas R, Alcaraz JL, Marín JM. [Retinopathy of prematurity in the Murcia region of Spain. Incidence and severity]. Archivos de la Sociedad Espanola de Oftalmologia 2008;83:423-8.

Lala-Gitteau E, Majzoub S, Saliba E, Pisella PJ. [Epidemiology for retinopathy of prematurity: risk factors in the Tours hospital (France)]. Journal francais d’ophtalmologie 2007;30:366-73.

Coutinho I, Pedrosa C, Mota M, et al. Retinopathy of prematurity: results from 10 years in a single neonatal intensive care unit. Journal of Pediatric and Neonatal Individualized Medicine (JPNIM) 2017;6:e060122-e.

Vieira BC, Nascimento M, Ribeiro I, Carvalho R, Martins JN. Resultados de 12 anos de rastreio da retinopatia da prematuridade no Hospital Pedro Hispano. Revista Sociedade Portuguesa de Oftalmologia 2013;37.

Moinho R, Morais S, Monteiro M, Mimoso G. Retinopatia da prematuridade numa unidade de cuidados intensivos neonatais: experiência de oito anos. 2015.

Lopes PJF, Teixeira F, Santo RE, Sousa FC, Rosa R. Retinopatia da Prematuridade numa Unidade de Cuidados Intensivos Neonatais de referência nacional. Revista Sociedade Portuguesa de Oftalmologia 2020;44.

Fierson WM, Ophthalmology AAoPSo. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2018;142.

Hellström A, Hård AL. Screening and novel therapies for retinopathy of prematurity - A review. Early human development 2019;138:104846.

Mora JS, Waite C, Gilbert CE, Breidenstein B, Sloper JJ. A worldwide survey of retinopathy of prematurity screening. British Journal of Ophthalmology 2018;102:9-13.




How to Cite

Liz Almeida R, Monteiro Costa R, Bennett M, Alfaiate M, Basto L. Retinopathy of prematurity: Eight-year outcomes of a Portuguese neonatal intensive care unit. REVNEC [Internet]. 2023Sep.14 [cited 2024Jun.20];32(2):82-8. Available from:



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