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Retinopathy of prematurity in infants with birth weight>or=1250 grams-incidence, severity, and screening guideline
Tammy L Yanovitch1, R Michael Siatkowski, Maryanne McCaffree
1University of Oklahoma, Department of Ophthalmology, Dean A. McGee Eye Institute, Oklahoma City, OK 73104, USA.
Insights
Retinopathy of prematurity (ROP) affects 4.2% of infants weighing 1250-1800g. Modified screening for infants with risk factors can improve outcomes and cost-effectiveness.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Optimal screening strategies are crucial for early detection and intervention, particularly in infants with specific birth weights (BW).
Purpose of the Study:
- To determine the incidence and severity of ROP in infants with BW between 1250 and 1800 g.
- To examine the influence of systemic conditions on ROP development in this population.
- To evaluate the cost-effectiveness of various ROP screening guidelines.
Main Methods:
- Retrospective review of 259 infants with BW 1250-1800 g screened for ROP over 3 years.
- Data collected included ROP presence/severity and potential risk factors (RF): sepsis, meningitis, necrotizing enterocolitis, intraventricular hemorrhage, pneumothorax, high bilirubin, central line, prolonged antibiotics, multiple RBC transfusions, and mechanical ventilation.
- Statistical analysis to identify predictors of ROP.
Main Results:
- Overall ROP incidence was 4.2%. Infants with stage 3 ROP had significantly lower BW and gestational age.
- No infant with BW > 1500 g developed treatable ROP.
- For infants weighing 1501-1800 g, sepsis, prolonged ventilation, extended antibiotic use, multiple RBC transfusions, and central line placement were significant predictors of ROP. Infants with ROP in this weight group had at least two RF.
Conclusions:
- Current screening guidelines identify high-risk ROP cases.
- Modified screening criteria (BW ≤ 1500 g or BW 1501-2000 g with ≥ 2 RF) are cost-effective, yielding a $587.85 benefit per infant screened.
- Targeted screening can optimize resource allocation and improve ROP management.
Purpose:
To determine the incidence and severity of retinopathy of prematurity (ROP) in infants with birth weight (BW) 1250 to 1800 g, to examine the influence of systemic conditions on the development of ROP in this population, and to evaluate the cost-effectiveness of various screening guidelines.
Methods:
We reviewed records from 259 consecutive infants with BW 1250 to 1800 g who were screened for ROP over a 3-year period. Extracted data included presence and severity of ROP, and the following potential risk factors (RF) for ROP development: sepsis, meningitis, necrotizing enterocolitis, intraventricular hemorrhage greater than stage I, pneumothorax, direct bilirubin>2 mg/dl, central line placement, antibiotic treatment>14 days, greater than seven red blood cell (RBC) transfusions, and mechanical ventilation>96 hours.
Results:
The overall incidence of ROP in this population was 4.2%. Two infants had stage 3 ROP, one with plus disease. Infants with stage 3 ROP had significantly lower BW (1299 versus 1484 g, P=0.013) and gestational age (GA) (28 versus 31 weeks, P=0.002) than those with no ROP. No infant with BW>1500 g developed treatable ROP. Conditions that best predicted ROP development in the 1501 to 1800 g BW group were sepsis, ventilation >96 hours, antibiotic use >14 days, RBC transfusions greater than seven units, and central line placement (P=0.001, P=0.001, P=0.012, P=0.014 and P=0.035, respectively). All infants with BW>1500 g who developed ROP had greater than or equal to two of these RF.
Conclusions:
All cases of high-risk ROP would have been identified by current screening guidelines. Modified screening criteria of infants with (1) BW
