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A risk scoring model to predict progression of retinopathy of prematurity for Indonesia
Johanes Edy Siswanto1,2, Asri C Adisasmita3, Sudarto Ronoatmodjo3
1Neonatology Working Group, Department of Pediatrics, Harapan Kita Women and Children Hospital, Jakarta, Indonesia.
Insights
A new scoring model accurately predicts retinopathy of prematurity (ROP) progression in preterm infants. This tool helps identify high-risk infants needing specialist care, addressing screening limitations in Indonesia.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in preterm infants.
- Regular screening is crucial for early detection and treatment of ROP.
- Limited access to pediatric ophthalmologists in Indonesia hinders timely ROP screening and treatment for many infants.
Purpose of the Study:
- To develop and validate a scoring model for predicting ROP progression in preterm infants in Indonesia.
- To assess the internal and external validity of the developed scoring model.
Main Methods:
- Data from 98 preterm infants with ROP (2009-2014) were used for internal validation.
- External validation utilized data from 62 preterm infants with ROP (2017-2020).
- Risk factors including oxygen duration and saturation monitor settings were analyzed to develop predictive models.
Main Results:
- Key risk factors identified include duration of oxygen supplementation, gestational age, socio-economic status, place of birth, and oxygen saturation monitor settings.
- Two models were developed, one based on oxygen duration and another on oxygen saturation monitor settings, showing similar sensitivity and specificity for Type 1 ROP progression.
- The ROP risk model demonstrated excellent external validity with 100% sensitivity and 73% specificity for predicting progression.
Conclusions:
- A validated ROP risk scoring model can effectively predict which infants with early-stage ROP are likely to progress to severe disease.
- This model can aid in identifying infants requiring referral to pediatric ophthalmologists for timely treatment.
- The ROP risk scoring model offers a valuable tool to overcome screening limitations in resource-constrained settings.
Introduction:
Retinopathy of prematurity (ROP) is a serious eye disease in preterm infants. Generally, the progression of this disease can be detected by screening infants regularly. In case of progression, treatment can be instituted to stop the progression. In Indonesia, however, not all infants are screened because the number of pediatric ophthalmologists trained to screen for ROP and provide treatment is limited. Therefore, other methods are required to identify infants at risk of developing severe ROP.
Objective:
To assess a scoring model's internal and external validity to predict ROP progression in Indonesia.
Method:
To develop a scoring model and determine its internal validity, we used data on 98 preterm infants with ROP who had undergone one or more serial eye examinations between 2009 and 2014. For external validation, we analyzed data on 62 infants diagnosed with ROP irrespective of the stage between 2017 and 2020. Patients stemmed from one neonatal unit and three eye clinics in Jakarta, Indonesia.
Results:
We identified the duration of oxygen supplementation, gestational age, socio-economic status, place of birth, and oxygen saturation monitor setting as risk factors for developing ROP. We developed two models-one based on the duration of supplemental oxygen and one on the setting of the oxygen saturation monitor. The ROP risk and probabilistic models obtained the same sensitivity and specificity for progression to Type 1 ROP. The agreement, determined with the Kappa statistic, between the ROP risk model's suitability and the probabilistic model was excellent. The external validity of the ROP risk model showed 100% sensitivity, 73% specificity, 76% positive predictive value, 100% negative predictive value, positive LR +3.7, negative LR 0, 47% pre-test probability, and 77% post-test probability.
Conclusion:
The ROP risk scoring model can help to predict which infants with first-stage ROP might show progression to severe ROP and may identify infants who require referral to a pediatric ophthalmologist for treatment.
