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Do extremely preterm infants need retinopathy of prematurity screening earlier than 31 weeks postmenstrual age?
Amy J Sloane1, Elizabeth A O'Donnell1, Amy B Mackley2
1Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA, USA.
Insights
Screening extremely preterm infants for retinopathy of prematurity (ROP) before 31 weeks postmenstrual age is not beneficial. No infants under 27 weeks gestation developed severe ROP early, supporting current screening guidelines.
Area of Science:
- Neonatal ophthalmology
- Perinatal medicine
- Retinopathy of prematurity research
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants.
- Current guidelines recommend ROP screening at specific postmenstrual ages (PMA).
- The 2018 American Academy of Pediatrics (AAP) guidelines suggest initiating ROP screening at 31 weeks PMA for extremely preterm infants.
Purpose of the Study:
- To evaluate the clinical utility of screening extremely preterm infants for ROP at 4 weeks chronologic age.
- To determine if earlier ROP screening, prior to 31 weeks PMA, identifies infants requiring treatment.
Main Methods:
- Retrospective analysis of infants born <27 weeks gestation.
- Data collected from two tertiary Neonatal Intensive Care Units (NICUs) between 2006 and 2018.
- Analysis of eye examinations performed by 32 weeks PMA.
Main Results:
- 550 infants (gestational age 25.1 ± 1.2 weeks) underwent 1310 eye examinations by 32 weeks PMA.
- 51.6% of examinations were performed before 31 weeks PMA.
- No infants required laser therapy for ROP before 32 weeks PMA; only 15.8% of infants ultimately needed treatment.
Conclusions:
- Screening extremely preterm infants for ROP earlier than 31 weeks PMA did not identify any infants requiring treatment.
- Findings support the 2018 AAP recommendation to initiate ROP screening at 31 weeks PMA.
- Early screening before 31 weeks PMA for ROP in infants <27 weeks gestation lacks clinical utility.
Objective:
To evaluate the utility of screening all extremely preterm infants for retinopathy of prematurity (ROP) at 4 weeks chronologic age, which is earlier than recommended by the 2018 AAP guidelines.
Study Design:
Retrospective analysis of infants <27 weeks gestation from two tertiary NICUs between 2006 and 2018 who survived until first eye examination.
Results:
550 infants (gestational age 25.1 ± 1.2 weeks and birth weight 758 ± 323 g) had 1310 examinations performed by 32 weeks postmenstrual age (PMA), and 676 (51.6%) of these were prior to 31 weeks PMA. No examinations in infants prior to 31 weeks PMA met the criteria for laser therapy. Of 87/550 infants (15.8%) who required laser therapy, none did so prior to 32 weeks PMA.
Conclusions:
No infants born <27 weeks gestation were found to have severe ROP prior to 31 weeks PMA, supporting the most recent AAP recommendation of initiating ROP screening at 31 weeks PMA for extremely preterm infants.
