541 - Quality Improvement Project to Reduce Severe Retinopathy of Prematurity among High-Risk Premature Infants in Neonatal Intensive Care Unit: A Journey to Zero

Publication Number: 541.6085

Maria Fe B.. Villosis, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Ma. Teresa Ambat, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Karine Barseghyan, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Kambiz K. Rezaie, Kaiser Permanente Souther California - Panorama City, Panorama City, CA, United States; Harry Chang, Kaiser Permanente Bernard J. Tyson School of Medicine, Panorama City, CA, United States; Alexandra Diamond, Kaiser Permanente panorama city, Panorama City, CA, United States; Abiola Olowoyeye, Southern California Permanente Medical Group, Los Angeles, CA, United States; Brian Lee, Kaiser Permanente Bernard J. Tyson School of Medicine, Los Angeles, CA, United States; Fu-Sheng Chou, Kaiser Permanente Bernard J. Tyson School of Medicine, Riverside, CA, United States; David Braun, Southern California Permanente Medical Group, Santa Monica, CA, United States

Background: Retinopathy of prematurity (ROP) is the leading preventable and treatable cause of childhood blindness in the United States. The World Health Organization (WHO) has identified ROP as a major cause of preventable childhood blindness worldwide. Severe ROP has also been shown to predict mortality and neurosensory impairment. The incidence of severe ROP has been increasing with improving survival of extremely preterm infants. A highly variable rate of 3-36% was reported by multicenter groups. Significant variations in severe ROP rates could be attributed to differences in clinical practice.

Objective: To evaluate the incidence of severe ROP (defined as stage 3 or greater or ROP surgery) during the period (2009-2023) when KFH-PC ROP bundle was implemented.

Design/Methods: Data were collected and reviewed retrospectively in a cohort of 649 infants admitted to KFH-PC NICU between 2009-2023 utilizing Vermont Oxford Network (VON) and California Perinatal Quality Care Collaborative (CPQCC) databases. Infants born at 31 weeks gestation or less and/or Very Low Birthweight (VLBW) infants - those with birth weights at 1500 grams or less were included. The ROP prevention bundle consists of optimal oxygen saturation target at 85-95%, minimization of oxygen toxicity, bronchopulmonary dysplasia (BPD) prevention bundle, and exclusive human milk-based diet feeding protocol.

Results: The implementation of ROP prevention bundle has led to a sustainable decline in the incidence of severe ROP among VLBW infants at KFH-PC NICU with an average incidence of 1.8% (range 0-10.7%) during the years 2009-2023. From baseline of 3.6% in 2009, we achieved and sustained an incidence rate of 0% in the last 6 years (2018-2023) with reinforcement of the ROP prevention care bundle.
An overall incidence of 3% was found in the cohort of 364 infants (56% of the study infants) born less than 30 weeks gestation. The VON observed: expected ratio in the recent epoch (2021-2023) was 0.3 (5th and 95th confidence limits 0.1 and 0.7 respectively). The risk adjusted ROP rate for our center was 0% compared to CPQCC network adjusted risk of 6.3% in < 1500 grams or infants born < 29 weeks gestation in 2021-2023.

Conclusion(s): This study demonstrated that the incidence of severe ROP can be reduced by implementation of care bundles on ROP prevention including but not limited to strategies that minimize oxygen toxicity. In our NICU, a zero percent incidence rate of severe ROP among VLBW infants was achieved and sustained by the reinforcement of and consistent adherence to our preventive care bundle by our multi-disciplinary team.

Incidence of Severe ROP or ROP Surgery among High-Risk Premature Infants born in 2009-2023
PAS Graph ROP 2009-2023.pdf

CPQCC Adjusted Risk for Severe ROP among High Risk Infants born < 30 weeks or Birthweight < or equal 1500 grams


KP-PC ROP Prevention Bundle


Incidence of Severe ROP or ROP Surgery among High-Risk Premature Infants born in 2009-2023
PAS Graph ROP 2009-2023.pdf

CPQCC Adjusted Risk for Severe ROP among High Risk Infants born < 30 weeks or Birthweight < or equal 1500 grams


KP-PC ROP Prevention Bundle