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Retinopathy of prematurity: are we screening too many babies?
M R K Mathew1, A I Fern, R Hill
1Department of Opthalmology, Hairmyres Hospital, NHS Trust, E Kilbride, UK. mrkmanu@hotmail.com
Insights
Screening premature infants for retinopathy of prematurity (ROP) can be safely focused on those with birth weight <1251 grams and gestational age <30 weeks. This approach efficiently identifies treatable ROP while optimizing resource allocation in neonatal care.
Area of Science:
- Neonatal Ophthalmology
- Perinatal Medicine
- Public Health
Background:
- Advancements in neonatal care necessitate early detection of retinopathy of prematurity (ROP) in premature infants.
- ROP poses a significant risk to premature and very-low-birth-weight infants.
- Long-term, population-based studies on ROP risk factors are limited.
Purpose of the Study:
- To determine if birth weight <1251 grams and gestational age <30 weeks can serve as safe and efficient criteria for detecting treatable ROP.
- To ascertain the incidence and associated risk factors for ROP in a defined infant population.
- To inform management strategies for babies diagnosed with ROP.
Main Methods:
- Retrospective analysis of ROP screening data over an 8-year period.
- Inclusion criteria: infants with birth weight <1500 g or gestational age <32 weeks.
- Single examiner screened infants for ROP.
Main Results:
- ROP incidence was 31.2% (64/205 infants).
- Mean age at detection was 5.5 weeks.
- Applying stricter criteria (birth weight <1251 g, gestational age <30 weeks) would have reduced examinations by 27% while still capturing all severe ROP cases (Stage 3 and threshold ROP).
- Birth weight and gestational age were significant risk factors for ROP.
Conclusions:
- Ophthalmic examinations for ROP can be safely and efficiently focused on infants with birth weight <1251 grams and gestational age <30 weeks.
- Birth weight and gestational age are key determinants for ROP risk.
- Refined screening guidelines are needed to prioritize infants at risk for vision-threatening ROP stages.
Purpose:
With advancement in neonatal care units, early detection of retinopathy of prematurity (ROP) in premature and very-low-birth-weight infants is important. Numerous studies have reported an increased risk of ROP in prematurely born infants, but only few have been long-term and strictly population-based. The aim of the present study was to find out whether birthweight <1251 grams and gestational age <30 weeks could provide a safe and efficient means of detecting treatable ROP. We have retrospectively tried to ascertain the incidence and associated risk factors that may contribute to the management of babies with ROP.
Methods:
Infants either with a birth weight below 1500 g or a gestational age of less than 32 weeks were screened for ROP during an 8-year period by a single examiner. Results An incidence of 64/205 (31.2%) ROP was noted. The mean age at detection was 5.5 +/- 2 weeks of life. The maximum stage reached was stage 1 in 27 (13.2%), stage 2 in 24 (11.7%) and stage 3 in 10 (4.8%) babies. Threshold ROP was present in three (1.5%) babies. Significantly fewer (150/205 = 73%) babies would have been examined had a birth weight of <1251 grams and a gestational age <30 weeks been applied. there were five (8%) babies with birth weight >1250 grams and eight (12%) babies with gestational age >30 weeks amongst babies with ROP but all were stage 1 or stage 2. All the stage 3 ROP and the threshold ROP cases were babies with birth weight <1000 grams and gestational age below 28 weeks.
Conclusion:
Ophthalmic examination may be safely and efficiently concentrated in babies with birth weight <1251 grams and gestational age below 30 weeks. Birth weight (P < 0.005) and gestational age (P < 0.01) were the only significant risk factors. During this 8-year period there was no significant decrease in the number of babies screened for ROP and the overall incidence of all stages of the disease has remained constant. In the present series a lower incidence of severe ROP was noted compared to most previous studies. Our experience from this study suggests the need for further refinement of screening guidelines in order to focus screening on the vision-threatening stages of ROP.