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Validation of the SCREENROP Criteria for Retinopathy of Prematurity Screening: A Canadian Model for Consideration
Felicia Tai1, Yasmin Jindani2, Amit Mukerji3
1From the Department of Surgery (F.T., K.S.), Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada.
Insights
The SCREEN-ROP guidelines accurately identified all infants needing retinopathy of prematurity (ROP) treatment, preventing unnecessary screenings for 7.41% of neonates. This approach ensures optimal care while reducing patient and healthcare burdens.
Area of Science:
- Neonatal ophthalmology
- Perinatal medicine
- Public health policy
Background:
- Retinopathy of prematurity (ROP) screenings are crucial but can lead to infant distress and increased healthcare costs.
- Current guidelines aim to optimize screening protocols, but their effectiveness requires ongoing evaluation.
- The Seminal Canadian Recommendations for Evidence-Based Examination of Neonates for Retinopathy of Prematurity (SCREEN-ROP) guidelines were developed to reduce unnecessary screenings.
Purpose of the Study:
- To retrospectively evaluate the sensitivity and specificity of the SCREEN-ROP guidelines in a large Canadian urban setting.
- To determine if the SCREEN-ROP criteria accurately identify neonates requiring treatment for retinopathy of prematurity.
- To quantify the potential reduction in unnecessary ROP screenings using the SCREEN-ROP criteria.
Main Methods:
- Retrospective analysis of ROP screening and treatment data from McMaster Children Hospital (July 2016 - May 2024).
- Inclusion criteria: neonates who received at least one ROP exam or ROP treatment.
- Application of SCREEN-ROP criteria (birth weight <1200 g or gestational age <30 weeks) to the cohort.
Main Results:
- The study included 823 neonates, with 79 receiving ROP treatment.
- The SCREEN-ROP criteria demonstrated 100% sensitivity (95% CI: 95.44%-100%) in identifying all infants who required ROP treatment.
- Applying SCREEN-ROP criteria would have avoided unnecessary screenings for 61 infants (7.41%), with a specificity of 8.20% (95% CI: 6.33%-10.41%).
Conclusions:
- The SCREEN-ROP guidelines effectively identify all neonates requiring ROP treatment while significantly reducing the number of unnecessary screenings.
- Implementation of SCREEN-ROP guidelines could save healthcare resources and minimize patient morbidity associated with ROP examinations.
- Further validation in diverse international settings is recommended to support broader adoption of the SCREEN-ROP guidelines.
Purpose:
Reducing unnecessary retinopathy of prematurity (ROP) screenings in neonates is important for minimizing morbidity associated with such examinations including pain for the child, anxiety in parents, and conserving healthcare resources. The Seminal Canadian Recommendations for Evidence-Based Examination of Neonates for Retinopathy of Prematurity (SCREEN-ROP) guidelines recommend only screening babies with birth weight (BW) <1200 g or gestational age (GA) <30 weeks to prevent unnecessary screenings. This study aims to retrospectively test the sensitivity of SCREEN-ROP in a large urban Canadian setting for capturing babies requiring treatment for ROP.
Design:
Retrospective accuracy analysis of revised diagnostic testing criteria.
Methods:
All babies born at McMaster Children Hospital from July 1, 2016 to May 31, 2024 who: 1) received at least one ROP eye exam, or 2) received ROP treatment, were included. Birth weight (BW) and gestational age (GA) at birth were collected from Canadian Neonatal Network (CNN) and BORN Ontario, which stores all information on babies admitted to level 3 and level 2 Neonatal Intensive Care Units (NICUs), respectively. SCREEN-ROP criteria were applied to the cohort. Institutional ethics approval was obtained from Hamilton Integrated Research Ethics Board (REB #13216-C) and CNN (REB #04-062).
Results:
Sensitivity and specificity of the model was calculated with 95% confidence intervals. Chi-squarede test was used to compare the babies captured with SCREEN-ROP criteria versus prior criteria (GA<31 weeks or birth weight <1251 g). 823 unique babies were screened from July 1, 2016 to May 31, 2024 of which 79 unique babies were treated for ROP. Applying the SCREEN-ROP criteria captured all 79 babies requiring ROP treatment while avoiding another 61 babies (7.41%) from being unnecessarily enrolled into ROP screening. Sensitivity of SCREEN-ROP criteria for capturing babies requiring ROP treatment was 100% (95% CI: 95.44% to 100%), and the specificity was 8.20% (95% CI: 6.33% to 10.41%).
Conclusions:
By screening babies with BW <1200 g or GA <30 weeks, 7.41% of babies would have been saved from unnecessary ROP screenings, and all babies requiring ROP treatment would have been captured with 100% sensitivity. Further validation in other large centers and countries may allow for broader implementation of SCREEN-ROP guidelines.
