Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, , London, UK.
Arch Dis Child Fetal Neonatal Ed. 2014 May;99(3):F196-202. doi: 10.1136/archdischild-2013-304508. Epub 2013 Dec 20.
To report on retinopathy of prematurity (ROP) screening compliance against a national guideline, factors associated with non-compliance and effect on ROP treatment.
National cohort study using operational NHS data from the National Neonatal Research Database (NNRD) for the period 2009-2011.
161 (94%) neonatal units in England.
Infants born below 32 weeks' gestation and/or with a birth weight below 1501 g.
ROP screening status ('on-time', 'early', 'late', 'unknown') and associated infant and neonatal unit characteristics, ROP treatment.
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)).
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.
报告早产儿视网膜病变（ROP）筛查的依从性与国家指南相比的情况，以及不依从的相关因素及其对 ROP 治疗的影响。
使用全国新生儿研究数据库（NNRD）的 NHS 操作数据进行的全国队列研究，研究期间为 2009-2011 年。
英格兰的 161（94%）个新生儿单位。
胎龄小于 32 周且/或出生体重小于 1501 克的婴儿。
ROP 筛查状况（“按时”、“提前”、“延迟”、“未知”）以及相关的婴儿和新生儿单位特征、ROP 治疗。
在研究期间，按时筛查的婴儿比例有所增加（p<0.001）。在 19821 名符合条件的婴儿中，有 7602 名（38.4%）按照国家指南记录接受了 ROP 筛查；7474 名（37.8%）在推荐时间段之外接受了筛查；4745 名（16.7%）婴儿的数据缺失。对于在推荐筛查期间接受新生儿护理的 16411 名婴儿，延迟筛查与较低的胎龄显著相关（与按时筛查相比，每增加一周胎龄，相对风险比（RRR）（95%可信区间）为 0.83（0.80 至 0.86）），以及在每年提供少于 500 天重症监护的新生儿单位接受护理（2.48（0.99 至 4.99））。延迟筛查的婴儿接受 ROP 治疗的可能性几乎高出 40%（比值比（OR）（95%置信区间）为 1.36（1.05 至 1.76））。
了解新生儿单位之间的组织差异可能有助于改善 ROP 筛查。基于患者的 NHS 电子临床数据为未来提供了快速、低成本、基于人群的评估机会，但需要改进数据录入。
