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An AND versus OR study of retinopathy of prematurity screening criteria
Taylor L Aaserud1, Laurel Lam2, Samantha Pastore1
1Cooper Medical School of Rowan University, Camden, New Jersey.
Insights
Current retinopathy of prematurity (ROP) screening is overly sensitive. Excluding infants who meet only one criterion (gestational age or birth weight) for ROP screening is safe and reduces unnecessary exams.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Current US screening criteria for retinopathy of prematurity (ROP) are highly sensitive, leading to frequent, potentially unnecessary infant examinations.
- Indirect ophthalmoscopic ROP screenings can cause infant distress and necessitate specialized ophthalmologist expertise.
Purpose of the Study:
- To assess the safety and efficacy of excluding premature infants who meet only one screening criterion (gestational age or birth weight) from routine ROP examinations.
Main Methods:
- Retrospective review of ROP screening records for premature infants at a tertiary academic center (2012-2022).
- Comparison of demographics, birth weight, gestational age, ROP classification, treatment rates, and follow-up needs between infants meeting one criterion (OR group) versus both criteria (AND group).
Main Results:
- Of 759 infants, 181 were in the OR group and 578 in the AND group.
- No infants in the OR group developed treatment-requiring type 1 ROP, compared to 9.0% in the AND group (P < 0.001).
- Follow-up was needed for 49.7% of OR infants versus 79.9% of AND infants (P < 0.001).
Conclusions:
- Excluding infants who meet only one ROP screening criterion (gestational age or birth weight) maintains screening sensitivity while significantly reducing unnecessary examinations.
- Findings suggest re-evaluating current ROP screening guidelines in developed countries to improve specificity and decrease the burden of non-essential screenings.
Background:
The current United States screening criteria for retinopathy of prematurity (ROP) is highly sensitive (gestational age [GA] of ≤30 weeks or birthweight [BW] of ≤1500 g) and often result in unnecessary examinations. Indirect ophthalmoscopic ROP examinations can be stressful for infants and require fellowship-trained ophthalmologists. The purpose of this study was to evaluate the safety of excluding low-risk premature infants: those who only meet one criterion of either GA or BW.
Methods:
The medical records of premature infants who underwent ROP screening at a tertiary academic center between 2012 and 2022 were reviewed retrospectively. Demographics, BW, GA, ROP classification, rates of treatment, and need for subsequent inpatient follow-up were compared among patients that met only one criterion (OR group) versus both criteria (AND group).
Results:
A total of 926 charts were reviewed; 759 patients met the inclusion criteria. Of these, 181 (23.8%) OR neonates were compared to 578 (76.2%) AND neonates. No babies in the OR group developed treatment-requiring type 1 ROP, whereas 52 AND neonates (9.0%) required treatment for type 1 ROP (P < 0.001). Follow-up was necessary for 90 OR group neonates (49.7%) and 462 AND neonates (79.9%) (P < 0.001).
Conclusions:
No patients in the OR group developed treatment-requiring disease, suggesting that sensitivity is maintained with the exclusion of single criterion infants. This data, consistent with other published work, suggests use of the current guidelines in developed countries be reexamined to increase specificity and decrease the number of unnecessary ROP examinations.
