Clare Gilbert.
Retinopathy of Prematurity Epidemiology.
Med Channel Jan ;4(1):17-8.

Retinopathy of prematurity (ROP: or retrolental fibroplasia as it was called previously, was an unknown condition before the 1940s. It was first described in children who had been born prematurely in the United States of America, and, during the 1950s, ROP was an important cause of blindness in children in industrialised countries (the `first epidemic). Retinopathy of prematurity occurred because preterm and low birth weight babies were given unmonitored supplemental oxygen. This meant that premature babies started to survive, but the high blood oxygen levels damaged the immature retinal capillaries, causing abnormalities in the process of peripheral retinal vascularisation. Towards the end of the 1950s supplemental oxygen was realised to be a risk factor, and its use was restricted. This was followed by a reduction in the incidence of blindness from ROP, but a higher infant mortality rate and, very unfortunately, a higher incidence of children with cerebral pals, as a result of hypoxia and brain damage. Oxygen was used again in the 1960s, with monitoring of blood oxygen levels, but blindness from ROP began to re-emerge. The introduction of increasingly advanced technology, with accurate methods of monitoring blood oxygen levels and other parameters in the 1970s, was probable the major factor responsible for the low incidence of blindness due to ROP observed during this period. In situations where accurate monitoring of blood oxygen levels is not possible clinicians have to make dificult decisions between withholding oxygen on the one hand, which increases the risk of ischaemic cortical brain damage, and giving unmonitored supplemental oxygen oil the other hand, which can cause blindness from ROP. The risk of ROP is inversely related to gestational age and birth weight; in other words, the more premature or low birth weight the baby the greater the risk of developing ROP More very low birth weight (VLBW less than 1,500 grams at birth) and extremely low birth weight (ELBW less than 1,000 grants at birth) babies are surviving as neonatal services continue to improve. The population of babies at risk is therefore increasing, and there is some evidence that blindness front ROP is increasing again in some industrialised countries (the `second epidemic`). In industrialised countries blindness from ROP is now largely restricted to infants in the FLBW group.

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