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A Good Way to Reduce Screening for Retinopathy of Prematurity: Development of the ROP Model in a China Preterm
Wenqian Ding1, Chenghan Luo2, Xinru Cheng1
1Neonatal Intensive Care Unit, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Insights
New risk factors for retinopathy of prematurity (ROP) were identified, including weight gain rate, blood transfusions, mechanical ventilation, and NT-proBNP levels. These findings improve ROP screening for all infants, not just high-risk ones.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Pediatric Critical Care
Background:
- Retinopathy of prematurity (ROP) is a leading preventable cause of childhood blindness.
- Current screening guidelines may overtreat low-risk infants, necessitating refined risk assessment.
- Identifying novel risk factors can optimize screening protocols and resource allocation.
Purpose of the Study:
- To identify novel, independent risk factors for ROP beyond gestational age and birth weight.
- To develop a more accurate predictive model for ROP risk in neonates.
- To enhance current ROP screening strategies for improved clinical outcomes.
Main Methods:
- Retrospective cohort study of 2,040 infants in a neonatal intensive care unit (NICU).
- Evaluation of 27 candidate risk factors using univariate and multivariate logistic regression.
- Development of a nomogram and Receiver Operating Characteristic (ROC) curves for risk prediction.
Main Results:
- Low weight gain rate, blood transfusions, invasive mechanical ventilation, and elevated NT-proBNP (≥ 25,000 ng/L) were identified as independent ROP risk factors.
- The final multivariate model demonstrated high predictive accuracy with an Area Under the Curve (AUC) of 0.90.
- Gestational age and birth weight remained significant predictors, alongside the newly identified factors.
Conclusions:
- The study identified key factors that refine ROP risk assessment in all eligible infants.
- A predictive model incorporating these new factors can aid clinicians in targeted ROP screening.
- These findings support the development of more precise and efficient ROP screening protocols.
Abstract:
Importance: Retinopathy of prematurity (ROP) is a preventable cause of blindness in children. Without treatment, more than 45% of eyes may suffer permanent vision loss. Current ROP screening guidelines, which include a range of birth weights (BWs) and gestational ages (GAs), may require screening many low-risk preemies who might develop severe ROP. Method: All high-risk infants in the neonatal intensive care unit (NICU) of the First Affiliated Hospital of Zhengzhou University from 2017 to 2021 were included in this retrospective cohort study. Each of the 27 candidate risk factors was evaluated in univariate analysis and adjusted for known risk factors (i.e., GA and BW). The significant results were analyzed in a backward selection multivariate logistic regression model. Receiver operating characteristic (ROC) curves and a nomogram were drawn. Results: The study included 2,040 infants who underwent ROP screening. The weight gain rate [OR, 2.65; 95% confidence interval (CI), 1.49-1.21 ≤ 12 g/d vs. > 18 g/d; P = 0.001], blood transfusion (OR, 2.03; 95% CI, 1.14-3.64; P = 0.017), invasive mechanical ventilation (OR, 1.74; 95% CI, 1.15-2.66; P = 0.009) and N-terminal segment of pro-B-type natriuretic peptide (NT-proBNP) ≥ 25,000 ng/L (OR, 1.51; 95% CI, 1.00-2.28; P = 0.048) were four new statistically independent risk factors in addition to GA and BW. The area under the curve (AUC) of the final multivariate model was 0.90 (95% CI, 0.88-0.92; P < 0.001). Conclusions and Relevance: These findings add to our understanding of ROP screening because they include all eligible infants rather than only high-risk infants, as in previous studies. Under the control of BW and GA, low weight gain rate, increased number of blood transfusion, invasive mechanical ventilation and NT-proBNP ≥ 25,000 ng/L were "new" statistically independent risk factors for ROP. The ROP risk can be calculated manually or represented by a nomogram for clinical use.
