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Early weight gain predicts retinopathy in preterm infants: new, simple, efficient approach to screening
Ann Hellström1, Anna-Lena Hård, Eva Engström
1Department of Pediatric Ophthalmology, The Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden. ann.hellstrom@medfak.gu.se
Insights
Incorporating postnatal weight gain into risk assessments can identify infants at risk for retinopathy of prematurity earlier. This method accurately predicts which infants need treatment, reducing unnecessary eye exams.
Area of Science:
- Neonatology
- Ophthalmology
- Pediatric Growth Monitoring
Background:
- Retinopathy of prematurity (ROP) risk is typically assessed using gestational age and birth weight.
- Current screening identifies infants benefiting from treatment (approx. 10%), necessitating serial examinations.
- Hypothesis: Postnatal weight gain data can improve early and specific identification of ROP risk.
Purpose of the Study:
- To evaluate if incorporating postnatal weight gain into risk assessment models can more accurately and earlier identify infants at risk for sight-threatening retinopathy of prematurity.
- To determine the efficacy of a surveillance system based on weight gain rate in predicting ROP requiring treatment.
Main Methods:
- Retrospective analysis of weekly infant weights (birth to 36 postmenstrual weeks) from 354 infants screened/treated for ROP.
- Utilized a surveillance system to flag decreased weight gain rates.
- Excluded one infant with nonphysiologic weight gain (hydrocephalus).
Main Results:
- 36% of infants received no "alarm"; 40% received low-risk alarms after 32 weeks, none developing ROP requiring treatment.
- 24% of infants received high or low-risk alarms before 32 weeks.
- Of those with early alarms, 41% developed proliferative ROP, and 29% required treatment for sight-threatening disease; median alarm-to-treatment time was 9 weeks.
Conclusions:
- The developed algorithm, incorporating weight and insulin-like growth factor, accurately identified 100% of infants who developed ROP requiring treatment.
- This method significantly reduces the need for costly eye examinations by approximately 75%.
- Early identification via postnatal weight evaluation allows for timely interventions, potentially preventing sight-threatening ROP.
Background:
The risk for sight-threatening retinopathy of prematurity is predicted by using gestational age and/or weight at birth. All infants below a threshold undergo serial ophthalmologic examinations for identification of those who would benefit from treatment (approximately 10%). We hypothesized that factoring in postnatal weight gain could identify children at risk for sight-threatening retinopathy of prematurity more specifically and earlier.
Methods:
Weekly weights from birth to postmenstrual week 36 were retrospectively entered into a surveillance system that gave an alarm when the rate of weight gain decreased to a certain level. For all children (N = 354) screened and/or treated for retinopathy of prematurity at Sahlgrenska University Hospital in 2004-2007, weekly weights were recorded. One child was excluded because of known nonphysiologic weight gain (hydrocephalus).
Results:
For 127 (36%) of 353 children, no alarm was given; for 40%, alarm at low risk was given after postmenstrual week 32. None of those children developed retinopathy of prematurity requiring treatment. Of the remaining 24% of children who received alarm at high or low risk before 32 postmenstrual weeks, 41% developed proliferative retinopathy of prematurity and 29% were treated because of sight-threatening disease. The median time from alarm to treatment was 9 weeks.
Conclusions:
The weight, insulin-like growth factor, neonatal retinopathy of prematurity algorithm detected early 100% of infants who developed retinopathy of prematurity requiring treatment and correctly predicted the majority who did not require treatment. With this simple postnatal evaluation, costly stressful eye examinations can be markedly reduced (approximately 75% of infants). In addition, early identification of children at risk may lead to the initiation of interventions and possibly prevent sight-threatening retinopathy of prematurity.
