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Validation of a Published Model to Reduce Burden of Retinopathy of Prematurity Screening
Jaron Pruett1, Kelly Ruland2, Sean Donahue3
1From the Vanderbilt University School of Medicine (J.P.) Nashville, Tennessee, USA.
Insights
Infants born after 27 weeks' gestational age with birthweights over 750 g who show no retinopathy of prematurity (ROP) by 37 weeks do not develop treatable ROP. Continued screening is unnecessary for these infants.
Area of Science:
- Neonatology
- Ophthalmology
- Pediatrics
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants.
- The E-ROP study suggested discontinuing ROP screening at 37 weeks for infants born at or after 27 weeks' gestational age with birthweights over 750 g if no ROP is present.
- This study aimed to validate these findings in a larger, multi-center cohort.
Purpose of the Study:
- To replicate and validate the E-ROP study's findings on the cessation of retinopathy of prematurity screening.
- To determine if infants meeting specific gestational age and birthweight criteria who have no ROP at 37 weeks develop treatable disease later.
Main Methods:
- Retrospective cohort study of 6729 infants screened for ROP.
- Chart review at 6 medical centers from February 2004 to April 2022.
- Evaluation of gestational age, birthweight, and ROP status at 37 weeks to identify "missed" cases.
Main Results:
- 298 (4.43%) of screened infants required treatment for ROP.
- Ten infants developed ROP after 37 weeks' gestational age.
- Only one infant >750 g birthweight and >27 weeks' gestational age developed ROP after 37 weeks, and it was detected at the first post-37-week examination.
Conclusions:
- Findings support the E-ROP study's conclusion: infants >750 g birthweight and >27 weeks' gestational age without ROP at 37 weeks do not develop treatable ROP.
- Termination of ROP screening at 37 weeks is supported for infants meeting these criteria.
- This validation in a larger cohort strengthens the evidence for refining ROP screening protocols.
Purpose:
The E-ROP study evaluated 1257 patients screened for retinopathy of prematurity (ROP), and found that no infant born at or after 27 weeks' gestational age and having a birthweight over 750 g developed treatable disease if they had no ROP at 37 weeks' gestational age. The study investigators suggested that there is little value in continued screening of infants meeting these criteria who have no ROP at 37 weeks. We attempted to replicate these published data in a larger multi-center cohort to validate or refute this hypothesis.
Design:
Retrospective cohort study.
Methods:
We conducted a chart review of every infant treated for ROP from February 2004 through April 2022 at 6 medical centers located in the mid-southern region of the United States. We evaluated gestational age, birthweight, and presence or absence of ROP at 37 weeks' gestational age to determine whether any treated infants would have been "missed" using these screening criteria.
Results:
Of 6729 infants screened, 298 (4.43%) received treatment. Ten infants who required treatment developed first evidence of ROP after 37 weeks' gestational age. However, only 1 infant was >750 g birthweight and >27 weeks' gestational age. This patient developed zone 2, stage 3 with pre-plus disease and was treated because of limited access to care at a remote hospital; however, ROP was detected at the first examination after 37 weeks, so this infant would have been identified for continued follow-up.
Conclusion:
Our results, in a cohort 5 times that of the original study, replicated that infants >750 g birthweight and >27 weeks' gestational age did not develop treatable ROP if they had no ROP at 37 weeks, supporting the termination of examination at that time in patients meeting these criteria.
