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Validation of WINROP algorithm as screening tool of retinopathy of prematurity among Egyptian preterm neonates
Asmaa Fares1,2, Sherif Abdelmonaim1, Dina Sayed1
1Pediatrics Department, Cairo University, Cairo, Egypt.
Insights
The WINROP system shows low sensitivity but high specificity in predicting retinopathy of prematurity (ROP) in Egyptian preterm infants. While helpful for ROP prediction, it requires modification with additional risk factors for improved accuracy.
Area of Science:
- Neonatal ophthalmology
- Public health
- Pediatric screening
Background:
- Retinopathy of prematurity (ROP) is a primary cause of preventable childhood blindness globally.
- Early detection through screening is crucial for preventing vision loss in infants.
- The WINROP (Weight, Insulin-like Growth Factor 1, Neonatal, Retinopathy of Prematurity) algorithm uses gestational age, birth weight, and weight gain to identify infants at risk for sight-threatening ROP.
Purpose of the Study:
- To assess the diagnostic accuracy of the WINROP algorithm for detecting sight-threatening ROP in Egyptian preterm neonates.
- To compare the WINROP system's predictions against standard ROP screening outcomes.
Main Methods:
- Prospective data collection of birth weight, gestational age, and weekly weight for 365 preterm infants.
- Inputting infant data into the WINROP algorithm to generate risk alerts.
- Calculating sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) by comparing WINROP alerts with ROP screening results.
Main Results:
- WINROP identified 62 infants with high-risk alarms, of whom 16 developed Type 1 or Type 2 ROP.
- WINROP identified 303 infants with low-risk alarms, of whom 15 developed Type 1 or Type 2 ROP.
- The algorithm demonstrated a sensitivity of 51.6%, specificity of 86.2%, PPV of 52.8%, and NPV of 95% for detecting Type 1 or Type 2 ROP.
Conclusions:
- The WINROP algorithm exhibits low sensitivity and high specificity for ROP detection.
- WINROP can aid in ROP prediction but should not be used as a standalone screening tool.
- Modifying the WINROP algorithm to include additional risk factors may enhance its sensitivity and optimize ROP examination rates.
Background:
Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness worldwide. Proper screening for ROP can prevent loss of vision. WINROP (weight, insulin-like growth factor 1, neonatal, retinopathy of prematurity) is an online surveillance system based on gestational age, birth weight and weekly weight gain that can predict infants at risk of sight-threatening retinopathy of prematurity.
Aims:
To evaluate the diagnostic accuracy of WINROP algorithm in detecting sight-threatening ROP in Egyptian preterm neonates.
Methods:
Birth weight (BW), gestational age (GA) and weekly weight measurement of 365 preterm infants were prospectively entered into WINROP algorithm. Based on these inputs, the algorithm would output and a screening was performed as is standard. Sensitivity, specificity, and predictive values were calculated by comparing WINROP outcomes with ROP screening outcomes.
Results:
Of the infants included in the study the mean GA was ±31.24 and mean BW was ±1508.78. A high risk WINROP alarm was triggered in 62 infants of whom 16 infants develop type 1 or type 2 ROP. These infants had associated comorbidities including sepsis, Intraventricular hemorrhage (IVH), Necrotizing enterocolitis (NEC), history of transfusion of packed red blood cells (RBCS) and history of platelet transfusion. A low risk WINROP alarm was triggered in 303 infants of whom 15 infants developed type 1 or type 2ROP. WINROP showed a sensitivity of 51.6%, a specificity of 86.2%, a positive predictive value (PPV) of 52.8% and a negative predictive value (NPV) of 95% for detection of type 1 or type 2 ROP.
Conclusion:
WINROP has low sensitivity and high specificity for detection of ROP. It may help in ROP prediction but can't be used alone. Modification of WINROP algorithm taking into account other risk factors may improve sensitivity and reduce number for ROP examination.
