Unstable Clinical Course Research Articles

Indian expert Delphi consensus on the diagnosis and management of flares of generalised pustular psoriasis.

Generalised pustular psoriasis (GPP) is a chronic, multisystemic, autoinflammatory disease with predominantly cutaneous manifestations, characterised by recurrent episodes of widespread, macroscopic and aseptic pustules. It has a highly unpredictable, heterogeneous and unstable clinical course. There are no consensus guidelines in India for the management of GPP. The objective of this Delphi panel study was to achieve consensus on problem areas in the understanding and management of GPP. Based on the inputs from an expert panel, 19 topics across six domains were identified as being important regarding the understanding and management of GPP. Statements were developed for these 19 topics, and consensus for the statements was sought using the modified Delphi method. Twelve experts evaluated the statements, indicating their agreement or disagreement. Consensus was considered to be reached when ≥80% of experts agreed with a statement. After two rounds of discussion, consensus was reached for 17 out of 19 (89%) statements and no consensus was achieved for two (11%) statements. We have presented the statements along with the respective degrees of consensus. Wherever relevant, clarifications or additional comments by experts are provided in the document.

Risk factors for the time to development of retinopathy of prematurity in premature infants in Iran: a machine learning approach

BackgroundRetinopathy of prematurity (ROP), is a preventable leading cause of blindness in infants and is a condition in which the immature retina experiences abnormal blood vessel growth. The development of ROP is multifactorial; nevertheless, the risk factors are controversial. This study aimed to identify risk factors of time to development of ROP in Iran.MethodsThis historical cohort study utilized data from the hospital records of all newborns referred to the ROP department of Farabi Hospital (from 2017 to 2021) and the NICU records of infants referred from Mahdieh Hospital to Farabi Hospital. Preterm infants with birth weight (BW) ≤ 2000 g or gestational age (GA) < 34 wk, as well as selected infants with an unstable clinical course, as determined by their pediatricians or neonatologists, with BW > 2000 g or GA ≥ 34 wk. The outcome variable was the time to development of ROP (in weeks). Random survival forest was used to analyze the data.ResultsA total of 338 cases, including 676 eyes, were evaluated. The mean GA and BW of the study group were 31.59 ± 2.39 weeks and 1656.72 ± 453.80 g, respectively. According to the criteria of minimal depth and variable importance, the most significant predictors of the time to development of ROP were duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of Total Parenteral Nutrition (TPN), mother age, birth order, number of surfactant administration, and on time screening. The concordance index for predicting survival of the fitted model was 0.878.ConclusionOur findings indicated that the duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of TPN, mother age, birth order, number of surfactant administrations, and on time screening are potential risk factors of prognosis of ROP. The associations between identified risk factors were mostly nonlinear. Therefore, it is recommended to consider the nature of these relationships in managing treatment and designing early interventions.

Clinico-epidemiologic Profile of Premature Infants Screened for and Diagnosed with Retinopathy of Prematurity at a Tertiary Government Hospital in Northeastern Luzon, Philippines

Abstract Aim: This study aims to determine clinical profiles and outcomes of premature infants screened with retinopathy of prematurity (ROP) at a hospital in Isabela in 2023. Materials and Methods: Analytical study of premature infants screened for ROP at the Department of Ophthalmology of a Tertiary Government Hospital in Northeastern Luzon, Philippines, in 2023. Results: Proportions of infants with any ROP and severe ROP were high (44% and 31%, respectively). More than half were lost to follow-up before retinal maturity which can further increase the number of infants with any and severe ROP in this study. The odds of developing any ROP were 26 × higher when an infant was &lt;32 weeks old and weighing &lt;1500 g compared to those referred for unstable clinical course only. The 57 infants with any ROP had a younger age of gestation (AOG) (P &lt; 0.001) and lower birth weight (P &lt; 0.001) compared to those without. AOG of infants with improvement and deterioration in the clinical course were significantly different (P &lt; 0.03). The 2013 guidelines had the least number missed before its recommended initial examination of infants diagnosed with any ROP (2.5%), including no type 1 ROP. Discussion: This is the first clinico-epidemiologic study on ROP done outside National Capital Region and postpandemic. High proportions of ROP and severe ROP can be due to the inclusion of high-risk infants born outside but referred to the hospital. The higher odds of developing any ROP in those with combined risk factors highlight the need for more public health efforts to decrease premature birth and birth of low birth weight infants.

Retinopathy of prematurity among infants admitted to two neonatal intensive care units in Ethiopia

ObjectiveThis study was conducted to determine the prevalence and risk factors for retinopathy of prematurity (ROP) in two neonatal intensive care units (NICUs) in Addis Ababa, Ethiopia.Methods and analysisA prospective...

INCIDENCE AND RISK FACTORS FOR RETINOPATHY OF PREMATURITY IN A LEVEL 3 NICU OF A TEACHING INSTITUTE IN MAHARASHTRA.

Background: Retinopathy of prematurity (ROP) is a serious complication seen in premature babies post treatment which can lead to blindness unless and until it is recognized and treated early. The objective was Objective: to estimate the incidence of ROP in preterm infants in Neonatal Intensive Care Unit (NICU) and to identify the risk factors which predispose to ROP. : ROP prospective screening survey was performed enrolling all premature Materials and Methods babies admitted to the NICU for a period of six months, with a gestational age of 34 weeks or less at birth and a birth weight of 2000gm or less. Those with a BW&gt;2000g or GA&gt;34 weeks with an unstable clinical course were included in the study as per recent IAP guidelines. The incidence of ROP in our study was 18.6%. Among babies with Results: gestational age less than 34 weeks had ROP incidence 31.1 %. No ROP was found in infants those who had weight of ≥ 2000g. Maximum babies had stage 2 ROP; only 1 baby had stage 1 ROP and all regressed spontaneously. Two babies had stage 3 ROP and required laser ablative therapy. Pearson Chi-Square test showed that there was a significant relationship between the occurrence of ROP and gestational age (P = 0.015) and low birth weight (P = 042) and number of days the baby was exposed to oxygen (p=0.0324). The incidence of ROP in our study was 18.6%. Low gestational Conclusion: age, low birth weight, oxygen therapy, were significant risk factors for ROP. Screening for early identification of retinal damage done soon after birth is important to prevent this blindness.

Incidence and Risk Factors for Retinopathy of Prematurity at a Rural Tertiary Hospital in Thailand.

To estimate the incidence and identify the factors affecting retinopathy of prematurity (ROP) in a rural tertiary hospital in Thailand. This retrospective chart review included all infants screened for ROP. The study included all infants with gestational age (GA) 30 weeks or birth weight (BW) 1,500 gr or selected larger infants with an unstable clinical course. Retinal findings were classified according to the revised International Classification of ROP. Data were analyzed using univariate and multivariable logistic regression analyses. Of the 113 screened infants, the incidences of any ROP and ROP requiring intervention were 17.7% and 8.8%, respectively. In univariate analysis, lower GA, lighter BW, total days of supplemental oxygen, days of continuous positive airway pressure (CPAP), presence of apnea, and intraventricular hemorrhage (IVH) were associated with the development of any ROP. In the stepwise multivariable logistic regression analysis, lighter BW, male gender, and bronchopulmonary dysplasia (BPD) were significant risk factors for the development of any ROP. Lower GA and being either a twin or triplet were significant risk factors for ROP requiring intervention. However, no antenatal condition was identified as a risk factor for ROP. The incidence of ROP in rural tertiary hospitals was relatively high as compared with previously published data from urban tertiary hospitals. Lighter BW, male gender, and BPD were significantly associated with the development of ROP in a local context. Epidemiological studies are necessary to prevent ophthalmic morbidities.

Risk factors associated with Retinopathy of Prematurity development and progression

Several studies propose that Retinopathy of Prematurity (ROP) is a multifactorial disorder implicating many prenatal and postnatal factors. The objective of our study was to determine the incidence and the risk factors that influenced ROP development and progression. We retrospectively compiled data of preterms with birth weight (BW) ≤ 1.500 g and/or gestational age (GA) < 32 weeks, or BW between 1.501 and 2.000 g and/or GA ≥ 32 weeks with oxygen supply > 72 h or unstable clinical course screened for ROP in Regional University Hospital of Málaga from 2015 to 2018. 202 infants (44.7%) developed ROP and 66 exhibited progression (32.7% of ROP infants). In the univariate analysis, many risk factors were associated with ROP. In the subsequent multivariate analysis, GA, oxygen therapy and weight at 28 days of life, mechanical ventilation duration, non-invasive ventilation, surfactant administration and late-onset sepsis were independently associated with the development. However, oxygen therapy duration, late-onset sepsis and weight at 28 days were associated with the progression. The ROP development and progression risk factors were different. Our results are important to facilitate screening, early diagnosis and ROP treatment while reducing unneeded examinations.

Tailoring Screening Guidelines for Retinopathy of Prematurity in Egypt: An Exploratory Multicentric Study.

Retinopathy of prematurity (ROP) is increasing in incidence in developing nations, including Egypt. Secondary prevention requires timely detection through the development of regional screening guidelines, which should be preceded by large-scale studies to characterize the population at risk. A prospective, multicentric exploratory study that included five large tertiary institutions in an urban Egyptian setting. All infants born with gestational age (GA) < 37 weeks and/or birth weight (BW) ≤ 2000 grams were screened. More mature and heavier infants with unstable clinical course were also included. The primary outcome measure was the rate of ROP and high-risk disease occurrence in relation to underlying risk factors. Of the 768 eyes (384 screened infants), 347 eyes (45.2%) had stage 1 or higher disease, and 43 eyes (5.6%) had high-risk disease. Eyes with stage 1 or higher ROP and treatment-requiring ROP had a mean (± SD) GA of 33.4 (± 2.6) weeks and 32.8 (± 3.2) weeks, and BW of 1842.3 (± 570.1) grams and 1747.6 ± (676.2) grams, respectively. Treatment-requiring eyes belonged to infants that had significantly lower GA and significantly higher prevalence of co-morbidities than non-treatment-requiring eyes. The incidence of ROP and high-risk disease in an urban Egyptian setting are similar to those in comparable settings elsewhere and locally. This exploratory study supports tailoring local screening criteria for ROP, and may aid the future development of national guidelines.

Retinopathy of Prematurity: A Study of Incidence and Risk Factors in a Tertiary Hospital in Vietnam.

ObjectiveTo determine the incidence and risk factors for the development of retinopathy of prematurity (ROP) in the neonatal intensive care unit (NICU) of Hue Central Hospital, Vietnam.MethodsA prospective study was performed in 214 preterm infants with gestational age (GA) ≤33 weeks and/or ≤1800 grams of birth weight (BW) or infants with a GA >33 weeks and a BW >1800 grams with an unstable clinical course who were screened for ROP in Hue Central Hospital, Vietnam.ResultsFifty-eight infants (27.1%) developed ROP; 39.7% cases were stage 1, 34.5% cases were stage 2, and 25.8% cases were stage 3. Gestational age (GA), birth weight, anemia, sepsis, respiratory distress syndrome, total days on oxygen supplementation > 1 week, continuous positive airway pressure (CPAP), mechanical ventilation, blood transfusion, and surfactant had a significant association with ROP in univariate analysis (p<0.05). Using multivariate analysis, GA less than 32 weeks, sepsis, and CPAP/mechanical ventilation remained independent risk factors for ROP development.ConclusionThe incidence of ROP in Vietnam was 27.1%. A GA less than 32 weeks, sepsis, and CPAP/mechanical ventilation are important risk factors for developing ROP.

RETINOPATHY OF PREMATURITY IN NEONATES WITH UNSTABLE CLINICAL COURSE

Objective: The objective of this study was to determine incidence of development of retinopathy of prematurity (ROP) in infants with GA ≥34 weeks or BW ≥1750 g having unstable clinical course. Methods: This was a cross-sectional study, all infants with GA ≥34 weeks or BW ≥1750 g having unstable clinical course were enrolled after taking informed consent from the parents. All these neonates were screened for ROP at 4 weeks of gestation age. Incidence of ROP was calculated and risk factors were also evaluated. Results: Out of total 426 admissions to neonatal intensive care unit, 52 babies satisfied the inclusion criteria and were enrolled in study. Incidence of ROP in neonates ≥34 weeks was 4%. Among the various neonatal factors, the presence of Bronchopulmonary dysplasia, administration of blood transfusions, and surfactant therapy were having significant association with ROP. Conclusion: ROP can even occur in babies with GA ≥34 weeks and normal birth weight neonates. Careful and timed retinal examination of all at risk infants will minimize the development of ROP and later on blindness which will lower the social and economic burden.

Association Between Social Determinants of Health and Retinopathy of Prematurity Outcomes

Previous studies suggest that race or ethnicity may be associated with risk for developing retinopathy of prematurity (ROP). Little is known about how socioeconomic factors mediate the relationship between race or ethnicity and ROP outcomes. To evaluate how socioeconomic factors, in the context of race and ethnicity, are associated with ROP outcomes. This retrospective cohort study used US Census Bureau income data and electronic medical records from neonatal intensive care units at 4 hospitals, UCLA Mattel Children's Hospital, UCLA Santa Monica Hospital, Cedars-Sinai Medical Center, and Harbor-UCLA Medical Center. Eligible participants included neonates born at a gestational age (GA) of 30 weeks or less, birth weight less than 1500 g, or a GA at birth greater than 30 weeks but with an unstable clinical course. Participants were screened for ROP between January 1, 2010, and December 31, 2020. Race and ethnicity data, GA, demographic and clinical information, proxy household income, and health insurance status were collected as risk factors. Diagnosis and severity of ROP were the main study outcomes. Severity was determined according to a classification system developed by the Early Treatment for Retinopathy of Prematurity Cooperative Group. In a crude model, Hispanic neonates were more likely to be diagnosed with ROP (OR, 1.70; 95% CI, 1.20-2.42) and had more severe ROP (OR, 2.24; 95% CI, 1.21-4.15) compared with non-Hispanic White neonates; these associations were no longer found when adjusting for GA and socioeconomic factors (OR, 1.12; 95% CI, 0.68-1.82, and OR, 1.67; 95% CI, 0.80-3.52, for ROP diagnosis and severity, respectively). In a fully adjusted model, lower GA was the primary predictor of ROP incidence (OR, 0.52; 95% CI, 0.48-0.57; P < .001), and higher median household income was associated with higher GA (OR, 0.26; 95% CI, 0.09-0.43; P = .002). In this cohort study, GA was the primary driver of disparities in ROP outcomes in a heterogeneous population of neonates in Los Angeles, California. When examined in the context of socioeconomic factors, GA did not differ between racial and ethnic groups. Studies of disparities associated with race and ethnicity should consider these constructs in conjunction with other sociodemographic factors and social determinants of health.

Analysis of a two-year independent screening effort for retinopathy of prematurity in rural Egypt

BackgroundThe third epidemic of retinopathy of prematurity (ROP) has majorly involved middle income countries in which tailored screening and local guidelines require development. The data regarding ROP prevalence and cutoff numbers for screening in Egypt are lacking.MethodsRetrospective analysis of an independent screening effort spanning 2 years (February 2019 to February 2021) and involving 32 neonatal care units within Sharkia governorate, Egypt. Infants of gestational age (GA) ≤ 34 weeks and/or birth weight (BW) ≤ 2000 g were included, as well as those with unstable clinical course. Two eyecare centers located in Sharkia and Cairo governorates served as referral centers for any required interventions.ResultsOf the 276 screened infants, 133 (48.2%) had some form of ROP that was bilateral in 127 (95.5%) of them. Aggressive posterior ROP (AP-ROP) was detected in both eyes of 24 infants (8.7%). The median (IQR) GA of infants with ROP was 32 (30–34) weeks, and the median (IQR) BW was 1600 (1350–2000) g. Sixty-three infants (47.4%) required treatment. Of the total 84 eyes that primarily were treated, 73 (86.9%) received intravitreal ranibizumab, 8 (9.5%) underwent laser ablation therapy, and 3 eyes (3.6%) underwent surgery. Recurrence rate was 16.7% (14 eyes). Final outcome was favorable in 83 eyes (98.8%). Applying the American Academy criteria would have led to the missing of 36.8% of infants with ROP and 28.6% of those requiring treatment in our sample.ConclusionThe incidence of both ROP and AP-ROP in the Egyptian rural setting appears to be in the high end of global reported rates. Prevention measures should urgently be planned and implemented.

O24 Malignancy in antiphospholipid syndrome: a catastrophe

O24 Malignancy in antiphospholipid syndrome: a catastrophe

Treatment of neovascular age related macular degeneration during COVID-19 pandemic: The short term consequences of unintended lapses.

Aim:To investigate the short-term effects of COVID-19 pandemic related unintended treatment lapses on neovascular age related macular degeneration (nAMD) patients.Methods:In this prospective cross-sectional study, 140 patients who had at least one anti-vascular endothelial growth factor (VEGF) injection for nAMD within 12 months before COVID-19 pandemic and who had at least 3 months of unintended lapse for control visits during pandemic were recruited and underwent a detailed opthalmological examination and optical coherence tomography imaging.Results:Of these 140 eyes, 113 (80.7%) were active with presence of either intraretinal and/or subretinal fluid and necessitated intravitreal anti-VEGF injections; and 20 (14.3%) of them complicated with subretinal hemorrhage. The mean interval of clinical visits and intravitreal antiVEGF injections were found to be prolonged during COVID-19 pandemics, which demonstrates a statistically significant lapse for both (p = 0.001 and p = 0.003 consecutively). The decreased visual acuity due to lapse was positively correlated with number of intravitreal anti-VEGF injections at last 6 months before COVID-19 pandemic (r = 0.217, p = 0.010) and central subfoveal thickness at first post-COVID-19 visit (r = 0.175, p = 0.038); and negatively correlated with follow-up duration (r = −0.231, p = 0.006) and number of control visits (r = −0.243, p = 0.004). Fifteen (16.9%) of the 89 patients who had drusen in the fellow eye before COVID-19 pandemic evolved to nAMD with an accompanying subretinal and/or intraretinal fluid.Conclusion:Unintended lapses during COVID-19 pandemic resulted with poor functional and structural outcomes for nAMD patients, especially for those at the beginning of the treatment period and who still have an unstable clinical course.

Perinatal inflammation influences but does not arrest rapid immune development in preterm babies

Infection and infection-related complications are important causes of death and morbidity following preterm birth. Despite this risk, there is limited understanding of the development of the immune system in those born prematurely, and of how this development is influenced by perinatal factors. Here we prospectively and longitudinally follow a cohort of babies born before 32 weeks of gestation. We demonstrate that preterm babies, including those born extremely prematurely (<28 weeks), are capable of rapidly acquiring some adult levels of immune functionality, in which immune maturation occurs independently of the developing heterogeneous microbiome. By contrast, we observe a reduced percentage of CXCL8-producing T cells, but comparable levels of TNF-producing T cells, from babies exposed to in utero or postnatal infection, which precedes an unstable post-natal clinical course. These data show that rapid immune development is possible in preterm babies, but distinct identifiable differences in functionality may predict subsequent infection mediated outcomes.

Retinopathy of prematurity in Rwanda: a prospective multi-centre study following introduction of screening and treatment services.

ObjectivesTo investigate risk factors for retinopathy of prematurity (ROP) in a newly established ROP screening and management programme in Rwanda, Africa.MethodsIn this multi-centre prospective study 795/2222 (36%) babies fulfilled the inclusion criteria (gestational age (GA) < 35 weeks or birth weight (BW) < 1800 g or unstable clinical course), 424 (53%) of whom were screened for ROP. 270 died before the first screening. ROP and treatment-warranted ROP were classified using the revised International Classification of ROP (2005). Data on maternal and perinatal risk factors were collected from daily neonatal notes.Results31 babies (7.3%, CI 5.0–10.2) developed any ROP, 13 of whom (41.9%, CI 24.5–60.9) required treatment. ROP was seen in six neonates with GA > 30 weeks and BW > 1500 g, one of whom required treatment. In univariate analysis the following were associated with any ROP: increasing number of days on supplemental oxygen (OR 2.1, CI 1.5–3.0, P < 0.001), low GA (OR 3.4, CI 1.8–6.4, P < 0.001), low BW (OR 2.3, CI 1.5–3.4, P < 0.001), at least one episode of hyperglycaemia ≥ 150 mg/dl (OR 6.6, CI 2.0–21.5, P < 0.001), blood transfusion (OR 3.5, CI 1.6–7.4, P < 0.001) or sepsis (OR 3.2, CI 1.2–8.6, P = 0.01). In multivariate analysis longer exposure to supplemental oxygen (OR 2.1, CI 1.2–3.6, P = 0.01) and hyperglycaemia (OR 3.5, CI 1.0–12.4, P = 0.05) remained significant.ConclusionsROP has become an emerging health problem in Rwanda, requiring programmes for screening and treatment. ROP screening is indicated beyond the 2013 American Academy guidelines. Improved quality of neonatal care, particularly oxygen delivery and monitoring is needed.

Особливості клінічного перебігу нестабільної стенокардії в жінок залежно від статусу куріння

Особливості клінічного перебігу нестабільної стенокардії в жінок залежно від статусу куріння

Incidence, risk factors and severity of retinopathy of prematurity in Turkey (TR-ROP study): a prospective, multicentre study in 69 neonatal intensive care units

BackgroundTo evaluate the prevalence, risk factors and treatment of retinopathy of prematurity (ROP) in Turkey and to establish screening criteria for this condition.MethodsA prospective cohort study (TR-ROP) was performed between...

Evaluating a Portable, Noncontact Fundus Camera for Retinopathy of Prematurity Screening by Nonophthalmologist Health Care Workers

To evaluate (1) the feasibility of non-ophthalmologist healthcare workers (HCWs) to obtain images of sufficient quality for retinopathy of prematurity (ROP) screening using a FDA-approved portable, non-contact, narrow-field fundus camera (i.e., Pictor™), and (2) the accuracy of grading these images to identify infants who developed treatment-warranted (type 1) ROP. Prospective cohort study. Infants undergoing routine ROP screening examinations (i.e. birth weight ≤1500 grams and/or gestational age ≤30 weeks or selected infants with a birth weight of 1500-2000g or gestational age >30 weeks and an unstable clinical course). We prospectively recruited infants undergoing ROP screening examinations at a community hospital. On the same day an ophthalmologist examined them, a trained HCW imaged their retinas using the non-contact camera. Two masked ROP experts graded these images remotely. We calculated both the percentage of gradable images (i.e. having at least 3 quadrants with sufficient image quality), as well as the accuracy of identifying infants who developed type 1 ROP. Percentage of gradable images and the sensitivity and specificity of each grader for identifying infants with type 1 ROP by grading for the presence of pre-plus or plus disease. Ninety-nine infants were included. Overall, 92.4% and 94.2% of all infant imaging sessions were considered gradable by graders 1 and 2, respectively. Amongst gradable images, the sensitivity of both graders for identifying type 1 ROP by grading for the presence of pre-plus or plus disease was 100% (95% confidence interval (CI): 95-100%) and the specificity 91% (95% CI: 83-95%) for grader 1 and 93% (95% CI: 86-96%) for grader 2. It was highly feasible for trained HCWs to obtain digital retinal images of sufficient quality for ROP screening using a non-contact fundus camera. By grading for the presence of pre-plus or plus disease, graders identified infants who developed type 1 ROP with high sensitivity and specificity. The use of portable, non-contact retinal cameras by trained HCWs could increase our workforce in ROP screening and identify infants needing an indirect ophthalmoscopy examination by an ophthalmologist.

RETINOPATHY OF PREMATURITY PRACTICES: A NATIONAL SURVEY OF CANADIAN NEONATAL INTENSIVE CARE UNITS

BACKGROUND: Retinopathy of prematurity (ROP) accounts for significant morbidity in preterm infants. Early detection and treatment helps prevent adverse sequelae. The objective of this study was to survey the current screening inclusion criteria, treatment options, supportive care and post screening events for ROP in tertiary level Neonatal Intensive Care Units (NICU’s) in Canada. OBJECTIVES: The objective of this study was to survey the current screening inclusion criteria, treatment options, supportive care and post screening events for ROP in tertiary level Neonatal Intensive Care Units (NICUs) in Canada. DESIGN/METHODS: The study was designed as a prospective observational study where a survey was sent out to all 29 level three NICU’s across Canada. Following ethics exemption from the local research ethics board, a cross sectional survey was distributed across all level three NICU’s in Canada from September 1 to December 30, 2015. The tool was designed to elicit information on the screening practices for detection of ROP in tertiary NICU’s. In addition, information on the ROP screening processes, including the timing of screening and grounds for screening infants outside the criteria were collected. The survey also explored the screening process from an organizational standpoint in terms of the person responsible for initiating the screening processes, choice of mydriatics as well as organizing follow up. The practice and use of supportive measures during ROP screening and treatment options provided were also captured.The primary outcome was defined as adherence to the current CPS/COS or AAP guidelines. Specifically, guideline adherence was assessed for the following criteria: inclusion of an infant for ROP screening, age at which first ROP exam was initiated, circumstances where infants outside the screening criteria were deemed eligible for inclusion in the screening process and appropriate follow up processes. Secondary outcomes were defined as the supportive practices in use during the ROP screening examination. This includes the type and dose of mydriatics used, and measures to reduce photophobia and discomfort after ROP related therapeutic interventions. We also assessed healthcare system perspectives related to ROP screening and treatment. This was determined by the availability of dedicated personnel to coordinate the exam, pre-printed order sheets for medication and equipment required, measures to ensure appropriate follow up, use of RetCam (Clarity Medical Systems INC.), ROP treatment options (Anti vascular endothelial growth factor [anti-VEGF] and/or Laser) and treatment location. RESULTS: Twenty two level three nurseries responded to the survey (76 % response rate). Ten different ROP screening inclusion criteria were found to be in use with significant variation in gestational age and birth weight criteria. Reasons for screening babies outside any given unit’s inclusion criteria included unstable clinical course or high oxygen demand as decided by the attending neonatologist. Many other national variations also exist regarding the supportive, procedural and treatment protocols surrounding ROP screening such as Ret Cam use, use of mydriatics and preprinted order sheets. From a treatment standpoint, 50 percent of the centers preferred laser while the remaing 50 percent prefereed Anti VEGF(Vascular Endothelial Growth factor) CONCLUSION: Despite national guidelines, there exists significant variation in ROP screening inclusion criteria practices among neonatal units in Canada. For the many other aspects of ROP screening and treatment, for which there are no national guidelines there also exists significant variations in practice patterns. There is therefore an urgent need for better evidence based screening guidelines as well as a need to standardize supportive measures surrounding ROP screening and treatment, followed by efforts to encourage national uptake of these recommendations.