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Optimization of retinopathy of prematurity screening in a tertiary neonatal unit in Northern Greece based on 16-year
Stella Moutzouri1, Anna-Bettina Haidich2, Aikaterini K Seliniotaki1
12nd Department of Ophthalmology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece.
Insights
Tightening screening criteria for retinopathy of prematurity (ROP) in premature infants can significantly reduce unnecessary examinations. New guidelines for ROP screening can spare over half of infants without missing critical treatment needs.
Area of Science:
- Neonatal ophthalmology
- Perinatal medicine
- Public health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Current screening protocols aim to detect treatment-requiring ROP (TR-ROP) but may lead to over-screening.
- Optimizing screening criteria is crucial for resource allocation and reducing infant burden.
Purpose of the Study:
- To evaluate the potential modification of ROP screening criteria within a specific unit.
- To determine if tightening gestational age (GA) and birth weight (BW) thresholds can reduce the number of infants screened without missing TR-ROP cases.
Main Methods:
- Retrospective analysis of infants screened for ROP between April 2004 and April 2020.
- Inclusion criteria: GA < 32 weeks and/or BW < 1501g, plus infants beyond these thresholds with comorbidities.
- Analysis of screening data to identify TR-ROP onset and evaluate the impact of modified criteria (GA < 30 weeks and/or BW < 1251g).
Main Results:
- Out of 1560 infants, 18.4% developed ROP, and 3.1% required treatment.
- TR-ROP was consistently identified at or after 32 3/7 weeks Postmenstrual Age (PMA).
- Reducing screening criteria to GA < 30 weeks and/or BW < 1251g would have excluded 52.9% of infants without missing any TR-ROP cases.
Conclusions:
- The current ROP screening policy can be optimized by tightening the criteria.
- Modified criteria (GA < 30 weeks and/or BW < 1251g) effectively identify all infants requiring treatment for ROP.
- This adjustment can significantly decrease the number of infants undergoing unnecessary ROP screening.
Objective:
The optimal modification of retinopathy of prematurity (ROP) screening policy in our unit, by tightening the applicable screening criteria, without missing treatment-requiring ROP (TR-ROP).
Study Design:
Retrospective analysis of screened infants with gestational age (GA) < 32 weeks and/or birth weight (BW) < 1501 g as well as cases beyond these thresholds but with comorbidities (April 2004 to April 2020).
Result:
Of 1560 included infants, 18.4% (n = 288) developed any stage of ROP and 3.1% (n = 49) were treated. TR-ROP occurred at a mean (SD) 362/7 (25/7) weeks PMA, and not before a minimum of 323/7 weeks PMA. No treated infant would have been missed if screening criteria were reduced to GA < 30 weeks and/or BW < 1251 g. This modification would have resulted in 826 (52.9%) fewer infants undergoing screening.
Conclusion:
Modifying the current screening criteria to GA < 30 weeks and/or BW < 1251 g would have spared over half of the screened infants from unnecessary examinations, without missing TR-ROP.
