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Can screening for retinopathy of prematurity be reduced?
J U M Termote1, A R T Donders, N E Schalij-Delfos
1Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center, Utrecht, The Netherlands. J.Termote@wkz.azu.nl
Insights
A new guideline for retinopathy of prematurity (ROP) screening can safely reduce the number of funduscopies. This method identifies infants needing ROP screening without missing those at high risk.
Area of Science:
- Neonatal ophthalmology
- Medical diagnostics
Background:
- Retinopathy of prematurity (ROP) screening is resource-intensive.
- Current screening protocols may lead to unnecessary procedures.
- A need exists for a more efficient ROP screening strategy.
Purpose of the Study:
- To develop a diagnostic screening guideline for ROP.
- To reduce the number of ROP screening funduscopies.
- To maintain safety by not missing infants at risk for threshold ROP.
Main Methods:
- Logistic regression analysis of 275 infants' data (1996-2000).
- Identification of significant risk factors for ROP.
- Development and validation of a diagnostic screening guideline using receiver operating characteristic curve analysis.
Main Results:
- Gestational age, birth weight, and erythrocyte transfusions were significant ROP risk factors.
- The developed guideline achieved an area under the curve of 0.793.
- The guideline could exclude 22.2% of infants from screening, missing only 3.8% of those with ROP stages 1-2.
Conclusions:
- A new diagnostic screening guideline can safely reduce ROP screening frequency.
- Implementation of this guideline can optimize resource allocation in neonatal eye care.
Background:
As screening for retinopathy of prematurity (ROP) is costly, time-consuming for the ophthalmologist and discomforting for the neonate, the minimum number of infants should be screened for ROP, without missing infants with severe ROP, at risk for threshold ROP.
Objectives:
To develop a diagnostic screening guideline for ROP that would safely reduce the number of ROP screening funduscopies in our department.
Methods:
Data of 275 infants admitted between 1996 and 2000 and screened for ROP according to our Dutch National guideline were studied. Significant risk factors for ROP were calculated, using logistic regression analysis and used to develop a guideline. The discriminative power of the guideline was evaluated using the area under the curve for the receiver operating characteristic curve.
Results:
Significant risk factors for ROP were: gestational age, birth weight and number of erythrocyte transfusions within the first 4 weeks of life. The combination of these 3 factors resulted in the highest area under the curve: 0.793. Using these 3 factors, a diagnostic screening guideline for ROP was developed: if birth weight + 2 x (gestational age - 20) - 6 x erythrocyte transfusion value within the first 4 weeks of life >or=34, no screening for ROP is necessary. Using this guideline, 22.2% of the infants of the study group could have been excluded from screening; 3.8% of the infants with ROP stages 1-2 would have been missed.
Conclusion:
In our department, ROP screening can be safely reduced using our diagnostic screening guideline.
