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Evaluating retinopathy of prematurity screening guidelines for 24- to 27-week gestational age infants
K A Kennedy1, L A Wrage2, R D Higgins3
1Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA.
Insights
Current retinopathy of prematurity (ROP) screening guidelines appear adequate for extremely premature infants. However, some infants develop severe ROP after discharge, necessitating continued post-discharge surveillance for timely treatment.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Critical Care
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Current screening guidelines aim to detect treatable ROP early.
Purpose of the Study:
- To evaluate the effectiveness of existing ROP screening guidelines in identifying treatable ROP in extremely premature infants.
- To assess the incidence and timing of severe ROP in a contemporary cohort.
Main Methods:
- Analysis of data from the Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial.
- Inclusion of infants born between 24 0/7 and 27 6/7 weeks gestational age (GA).
- Examinations followed American Academy of Pediatrics (AAP) screening recommendations based on postmenstrual age (PMA).
Main Results:
- 14% of surviving infants (137/997) developed severe ROP.
- The onset of severe ROP ranged from 32.1 to 53.1 weeks PMA.
- 1.4% of infants developed severe ROP after hospital discharge.
Conclusions:
- Contemporary data support the 2013 AAP ROP screening guidelines for infants within the studied GA range.
- A notable proportion of infants develop severe ROP post-discharge.
- Emphasizes the critical need for post-discharge follow-up for infants at risk of severe ROP.
Objective:
To determine whether current retinopathy of prematurity (ROP) screening guidelines adequately identify treatable ROP in a contemporary cohort of extremely low gestation infants.
Study Design:
Data from the Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial were used. Inborn infants of 24 (0)/7 to 27 (6)/7 weeks gestational age (GA) with consent before delivery were enrolled in 2005 to 2009. Severe ROP (type 1 ROP or treatment with laser, cryotherapy or bevacizumab) or death was the primary outcome for the randomized trial. Examinations followed the then current AAP (American Academy of Pediatrics) screening recommendations, beginning by 31 to 33 weeks postmenstrual age (PMA).
Result:
One thousand three hundred and sixteen infants were enrolled in the trial. Nine hundred and ninety-seven of the 1121 who survived to first eye exam had final ROP outcome determined. One hundred and thirty-seven (14% of 997) met criteria for severe ROP and 128 (93%) of those had sufficient data (without missing or delayed exams) to determine age of onset of severe ROP. PMA at onset was 32.1 to 53.1 weeks. In this referral center cohort, 1.4% (14/997) developed severe ROP after discharge.
Conclusion:
Our contemporary data support the 2013 AAP screening guidelines for ROP for infants of 24 (0)/7 to 27 (6)/7 weeks GA. Some infants do not meet treatment criteria until after discharge home. Post-discharge follow-up of infants who are still at risk for severe ROP is crucial for timely detection and treatment.
