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A proposal of screening guideline for retinopathy of prematurity in Taiwan
Mei-Chih Chiang1, Jen-Ruey Tang, Kuo-Inn Tsou Yau
1Department of Pediatrics, St. Martin de Porres Hospital, Chiayi, Taiwan.
Insights
This study suggests adjusting retinopathy of prematurity (ROP) screening criteria in Taiwan. Lowering screening to infants under 31 weeks gestational age or 1500g birth weight reduces screenings without missing significant ROP cases.
Area of Science:
- Neonatal Ophthalmology
- Public Health
- Pediatric Medicine
Background:
- Retinopathy of prematurity (ROP) is a significant cause of morbidity in premature infants.
- Current American Academy of Pediatrics (AAP) guidelines recommend ROP screening for infants with birth weights ≤ 1500g or gestational ages (GA) ≤ 28 weeks.
Purpose of the Study:
- To determine optimal ROP screening criteria (birth weight and GA) for premature infants in Taiwan.
- To evaluate the impact of adjusting screening guidelines on the number of infants requiring evaluation and the detection of ROP.
Main Methods:
- Retrospective review of 617 premature infants born at National Taiwan University Hospital (1994-1999).
- Infants survived >28 days and received eye-ground evaluation.
- Analysis of maximal ROP stage observed based on birth weight and GA.
Main Results:
- No ROP beyond stage I was observed in infants with birth weights >1500g and GA >31 weeks.
- Adjusting screening criteria to birth weight ≤1500g or GA ≤31 weeks reduced the number of infants screened by 37.2% without missing ROP > stage 1.
- Using AAP's GA ≤28 weeks criteria would have missed five cases of stage 2 ROP.
Conclusions:
- Recommended ROP screening criteria for tertiary nurseries in Taiwan: GA ≤31 weeks or birth weight ≤1500g.
- These adjusted criteria reduce screening burden while maintaining detection efficacy.
- Physician discretion is advised for screening larger infants at high risk for ROP.
Abstract:
Retinopathy of prematurity (ROP) is one of the most important morbidity in premature infants. The latest American Academy of Pediatrics (AAP) screening guidelines for ROP are mandatory for infants with birth weights < or = 1500 g or gestational ages (GA) < or = 28 weeks. To determine the appropriate upper limits for ROP screening in Taiwan in terms of birth weight and gestational age, we performed a retrospective review of all 617 infants who were born at the National Taiwan University Hospital from January 1, 1994 to December 31, 1999, and survived beyond 28 days of life and received eye-ground evaluation under our current ROP screening guidelines. From the start of our study, the criteria for screening was birth weight <2000 g or gestational age < 35 weeks. The maximal stage of retinopathy observed was recorded. We found no ROP greater than stage I in infants with birth weights > 1500g and GA > 31 weeks. In comparing with our current guidelines, lowering the screening criteria to birth weight < or = 1500g or gestational age < or = 31 weeks reduced the number of infants requiring screening by 37.2%, while no case of ROP greater than stage 1 was missed. However, five cases of stage 2 ROP would have been missed in our study if the gestational age cut-off was < or = 28 weeks as recommended by AAP. Therefore, we recommend that in the tertiary nursery in Taiwan, the gestational age < or = 31 weeks or birth body weight < or = 1500 g should be screened for ROP regardless of clinical condition. The screening for larger infants with high risk of ROP requires further discretion of the attending physicians.
