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Retinopathy of prematurity in 7 neonatal units in Rio de Janeiro: screening criteria and workload implications
Andrea A Zin1, Maria Elisabeth Lopes Moreira, Catey Bunce
1Department of Neonatology, Fernandes Figueira Institute, Rio de Janeiro, Brazil. andreazin@iff.fiocruz.br
Insights
Optimal screening for retinopathy of prematurity (ROP) in Brazil requires wider criteria (< or =1500 g or <35 weeks) for all neonatal units. This ensures infants needing treatment are identified, despite a slight workload increase.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants.
- Current screening criteria in Brazil may not adequately identify all infants requiring treatment.
- Neonatal unit survival rates can vary significantly, potentially impacting ROP incidence.
Purpose of the Study:
- To determine optimal screening criteria for ROP in Brazilian neonatal units.
- To evaluate the workload implications of different ROP screening protocols.
- To compare existing international and Brazilian criteria against local ROP treatment needs.
Main Methods:
- A retrospective study of 3953 eligible infants across 7 neonatal units in Rio de Janeiro over 34 months.
- Infants with birth weights ≤2000 g or gestational age <37 weeks were examined.
- ROP classification followed international standards; treatment was administered for type 1 ROP.
Main Results:
- 124 infants (3.6%) required treatment for ROP, including 11 for aggressive posterior ROP.
- High-survival NICUs (≥80% for <1500 g infants) would benefit from criteria of ≤1500 g or <32 weeks.
- Low-survival NICUs (<80%) require broader criteria of ≤1500 g or ≤35 weeks; existing criteria miss infants needing treatment.
Conclusions:
- Wider ROP screening criteria (≤1500 g or ≤35 weeks) are recommended for all Brazilian neonatal units.
- This approach ensures adequate ROP detection but may slightly increase workload city-wide.
- Further research is needed to determine if neonatal unit survival rates can guide ROP screening criteria.
Objectives:
The goals were to determine optimal screening criteria for retinopathy of prematurity (ROP) in 7 neonatal units in Rio de Janeiro, Brazil, and to explore the workload implications of applying different criteria.
Methods:
Infants with birth weights of < or = 2000 g or gestational age of <37 weeks were examined by 3 ophthalmologists in 7 of the largest units in Rio de Janeiro, during a 34-month period. ROP was classified by using the international classification, and laser treatment was given to infants developing type 1 ROP.
Results:
A total of 3437 (87%) of 3953 eligible infants were examined, of whom 124 (3.6% [range: 2.1%-7.8%]) were treated. Eleven infants were treated for aggressive posterior ROP. Appropriate screening criteria for the 2 NICUs with high survival rates (ie, > or =80% among infants with birth weights of <1500 g) would be < or =1500 g or <32 weeks. For NICUs with low survival rates (ie, <80%), appropriate criteria would be < or =1500 g or < or =35 weeks. UK, US, and previous Brazilian criteria would all miss infants needing treatment.
Conclusions:
ROP programs in Brazil should use the wider criteria of < or =1500 g or < or =35 weeks until further evidence-based criteria become available, although this would mean a slight increase in workload across the city, compared with use of the narrower criteria in the better units. Whether survival rates can be used as a proxy to indicate screening criteria requires further investigation.
