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Screening guidelines for retinopathy of prematurity: the need for revision in extremely low birth weight infants
1Department of Pediatrics, SUNY at Stony Brook, Stony Brook, New York 11794-8111, USA.
Insights
Early screening for retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) infants is crucial. Current guidelines may miss cases, necessitating screening by chronological age rather than postmenstrual age.
Area of Science:
- Neonatal Ophthalmology
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Early detection and intervention are critical for managing ROP and preventing vision loss.
Purpose of the Study:
- To evaluate the efficacy of current ROP screening guidelines in extremely low birth weight (ELBW) infants.
- To determine if significant ROP can be detected earlier than 31-33 weeks' postmenstrual age (PMA).
Main Methods:
- Retrospective review of medical records for ELBW infants (<1000 g) screened for ROP.
- ROP screening performed at 4-6 weeks' chronological age (CA), with follow-ups every other week.
- Analysis of PMA at diagnosis of prethreshold and threshold ROP.
Main Results:
- 30% of ELBW infants (78/258) developed prethreshold ROP.
- 35% of those with prethreshold ROP (27/78) progressed to threshold ROP.
- 10 infants (13% of those with prethreshold ROP) were diagnosed with threshold ROP before 34 weeks' PMA, with 3 diagnosed as early as 31 weeks' PMA.
Conclusions:
- A significant proportion of ELBW infants develop ROP early, potentially before 31-33 weeks' PMA.
- Using PMA alone for initial screening may delay diagnosis of threshold ROP.
- Initial ROP screening for ELBW infants should follow the chronological age guideline of 4-6 weeks.
Objective:
To determine whether significant retinopathy of prematurity (ROP) can be detected before 31 to 33 weeks' postmenstrual age (PMA) in extremely low birth weight (ELBW) infants.
Methods:
Medical records of all ELBW infants (<1000 g at birth) admitted to our regional perinatal center between April 1995 and January 1999 were reviewed retrospectively. Screening examinations for ROP were routinely performed at 4 to 6 weeks' chronological age (CA) from birth and followed at least every other week. Data were collected for infants who developed ROP. We determined the PMA at which the first screening eye examination demonstrated prethreshold disease and the subsequent examination that showed threshold disease (if it occurred). The percentages of infants who developed prethreshold ROP diagnosed at
Results:
All 258 ELBW infants were screened for ROP. Seventy-eight infants (30%) were diagnosed with prethreshold ROP. Twenty-seven of these infants (35%) progressed to threshold ROP. Ten infants who progressed to threshold ROP were <34 weeks' PMA at the time of this diagnosis. Of these 10 infants, 3 were diagnosed at 31 weeks' PMA, 4 at 32 weeks', and 3 at 33 weeks'.
Conclusion:
More than 80% of ELBW infants who developed prethreshold disease in this cohort were
