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The U.S.A. eligible retinopathy of prematurity screening population 2003-2022: WONDER-ROP Study
Henry P Moshfeghi1, Moosa Zaidi2, Jochen Kumm3
1Carleton College, Northfield, MN, United States of America.
Insights
The number of infants eligible for retinopathy of prematurity (ROP) screening in the U.S. has declined since 2007, with birth weight being the primary driver. Eligibility stabilized in the 2020s, reflecting overall birth trends.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
- Screening guidelines aim to identify infants at risk for ROP.
- Understanding trends in screening eligibility is crucial for resource allocation and public health initiatives.
Purpose of the Study:
- To analyze trends in the U.S. population eligible for ROP screening.
- To examine changes in eligibility based on birth weight (BW) and gestational age (EGA).
- To identify state-level variations in ROP screening eligibility.
Main Methods:
- Retrospective analysis of national data from the WONDER database (2003-2022).
- Categorization of infant eligibility based on BW, EGA, and combined criteria.
- Evaluation of trends in eligible infants, including micropremature and nanopremature populations.
Main Results:
- Eligible infant numbers peaked in 2007 and declined steadily, averaging 47,088 annually.
- Birth weight (BW) emerged as a stronger driver for screening eligibility than EGA.
- Significant state-level shifts in eligibility were observed, particularly in Texas and Florida.
Conclusions:
- The decreasing trend in ROP screening eligibility aligns with declining birth rates.
- BW is the primary national determinant for ROP screening eligibility.
- Trends in micro- and nano-premature infant eligibility reflect overall declines, with nano-premature infants showing a relative decrease.
Purpose:
To delineate the trends of the United States population eligible for retinopathy of prematurity (ROP) screening as defined by the Joint Statement Screening Guidelines of the American Academies of Pediatrics and Ophthalmology from the Centers for Disease Control using the Wide-ranging Online Data for Epidemiologic Research (WONDER) Database.
Design:
National, retrospective study.
Subjects:
Infants with ROP in the United States between 2003 and 2022.
Methods:
Data collected from WONDER database over the 20-year period 2003-2022.
Main Outcome Measured:
The parameters of state, infant birth weight (BW), and last menstrual period estimated gestational age (EGA). Four categories of qualification for ROP Screening eligibility were created: BW, EGA, combined BW and EGA (double eligible infants), and Unique Eligible Infants (UEI).
Results:
The number of eligible for ROP screening in the U.S peaked at 56,106 in 2007 and has steadily declined to 41,083 in 2022, averaging 47,088 per year throughout the study period. During the first ten-year period, there was an average of 50,895 eligible infants per year vs 43,281 infants per year during the second ten-year period. This was a statistically significant trend. BW slightly surpassed EGA as a driver for screening eligibility every year. Both the numbers of eligible micropremature (24-26 weeks GA and/or BW 600-800 g) infants and numbers of eligible nanopremature (<24 weeks GA and/or BW <600 g) infants mirrored the trendline overall eligibility trends. At the state level, Texas surpassed California in 2012 in terms of the highest number of eligible infants, and Florida surpassed New York in 2011 as the state with the third most eligible infants. These changes persisted until the end of the study period. State level changes were driven by EGA. For micropremature infants, California and New York demonstrated a decline in eligibility driven by both BW and EGA.
Conclusion:
Consistent with a drop in overall births, the numbers of eligible infants for ROP screening at birth have been decreasing since its peak in 2007, with stabilization in the 2020's. Nationally, BW drives eligibility. Both micro- and nano-premature infants have decreased in a manner that corresponds to overall eligibility with nano-premature infants having a slight relative decrease. This data adds important context to studies on infant survivability and ROP screening epidemiology.
