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Evaluating the Utility of Initial Examinations in Retinopathy of Prematurity: Proposal of FIRST-ROP Algorithm for a
Francisco Altamirano1, Melissa Yuan2, Sandra Hoyek2
1Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Insights
For infants not meeting microprematurity criteria, retinopathy of prematurity (ROP) requiring treatment is not detected in the first two examinations. Starting ROP screening at 34 weeks postmenstrual age (PMA) can reduce examinations by 30.6%.
Area of Science:
- Neonatal ophthalmology
- Perinatal medicine
- Pediatric screening
Background:
- Current retinopathy of prematurity (ROP) screening guidelines are resource-intensive.
- Optimizing ROP screening is crucial for medium-risk infants.
- Early detection and intervention for ROP are vital for preventing vision loss.
Purpose of the Study:
- To evaluate the diagnostic utility of the first two ROP examinations in a medium-risk infant cohort.
- To propose an optimized ROP screening protocol for specific infant populations.
- To reduce the number of ROP examinations without compromising patient safety.
Main Methods:
- Retrospective analysis of 1125 infants screened for ROP between 2017 and 2023.
- Inclusion criteria: infants born at ≥27 weeks gestational age and weighing ≥800 g.
- Primary outcomes: ROP and treatment-warranted ROP (TW-ROP) rates, timing of diagnosis, and number of examinations.
Main Results:
- 21.1% of infants had ROP, with 1.0% requiring treatment.
- No infants met type 1 ROP treatment criteria at the first or second examination (100% sensitivity for TW-ROP).
- Starting ROP screening at 34 weeks' PMA could reduce inpatient examinations by 30.6%.
Conclusions:
- The first two ROP examinations in medium-risk infants do not detect type 1 ROP.
- A revised screening algorithm (FIRST-ROP) starting at 34 weeks' PMA is proposed.
- This optimization can significantly decrease the number of ROP examinations for eligible neonates.
Purpose:
To assess the utility of the first or second examinations for retinopathy of prematurity (ROP) in a medium-risk cohort of infants and to propose an optimization to the current ROP screening guidelines.
Design:
Retrospective consecutive study.
Participants:
Infants screened for ROP between January 2017 and August 2023 at 3 different tertiary-level care neonatal intensive care units.
Methods:
Analysis of patients who did not meet criteria for microprematurity or nanoprematurity (those born at ≥ 27 weeks and weighing ≥ 800 g).
Main Outcome Measures:
The primary outcomes included the rates of ROP and treatment-warranted ROP (TW-ROP), the presence of TW-ROP at the first or second inpatient examinations, the number of inpatient examinations performed before the first ROP diagnosis, and the overall number of inpatient examinations performed.
Results:
A total of 2004 neonates were screened for ROP, among whom 1125 (56.1%) met the inclusion criteria. Of those, 237 neonates (21.1%) had ROP. Eleven infants (1.0%) required treatment for active disease. The median postmenstrual age (PMA) at first ROP diagnosis was 35.3 weeks (interquartile range [IQR], 33.7-37 weeks; range, 30.3-46.7 weeks). The median PMA at stage 3 diagnosis was 39.3 weeks (IQR, 38.3-41.2 weeks; range, 35.1-44.4 weeks). The median PMA at first treatment was 39.6 weeks (IQR, 35.8-43.3 weeks; range, 35.3-49.6 weeks). The median number of inpatient examinations was 2.0 (IQR, 1-4 examinations) for traditional screening, 1.0 examination (IQR, 1-3 examinations) after eliminating the first ROP inpatient examination, and 1.0 examination (IQR, 1-2 examinations) after eliminating the first and second ROP examinations (P < 0.001). No patients met type 1 ROP treatment criteria at either the first or second inpatient examination (100% sensitivity for TW-ROP). In this cohort, starting examinations at 34 weeks' PMA could save 30.6% of inpatient examinations.
Conclusions:
In infants not meeting criteria for microprematurity or nanoprematurity, no type 1 ROP was diagnosed at either of the first 2 inpatient examinations. We propose an amendment algorithm (FIRST-ROP) in which ROP examinations start at 34 weeks' PMA for neonates born at ≥27 weeks gestational age and ≥800 grams.
Financial Disclosure(S):
The author(s) have no proprietary or commercial interest in any materials discussed in this article.
