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A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn

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Validation of the "FIRST-ROP" Algorithm at a Neonatal Intensive Care Unit Tertiary Center over Three Decades.

Davina A Malek¹, Francisco Altamirano², Celine Chaaya³

¹From the Bascom Palmer Eye Institute (D.A.M., C.N., N.A., J.S.L., N.A.Y., H.U.H., A.M.B.), University of Miami, Miami, Florida, USA.

American Journal of Ophthalmology

|April 19, 2026

Summary

The FIRST-ROP algorithm safely defers retinopathy of prematurity screening to 34 weeks postmenstrual age in medium-risk infants. This approach reduces infant eye exam visits without missing treatment-warranted cases.

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Area of Science:

Ophthalmology
Neonatology
Pediatric screening

Background:

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness.
Current ROP screening guidelines involve frequent eye examinations for premature infants.
The FIRST-ROP algorithm proposes deferring initial screening to 34 weeks postmenstrual age (PMA).

Purpose of the Study:

To validate the efficacy of the FIRST-ROP algorithm in a medium-risk infant cohort.
To assess the safety and efficiency of deferring ROP screening to 34 weeks PMA.

Main Methods:

Retrospective diagnostic comparison of infants with gestational age ≥27 weeks and birth weight ≥800 g.
Comparison of ROP diagnosis and treatment-warranted ROP (TW-ROP) rates between standard screening and the FIRST-ROP algorithm.
McNemar test used to compare paired binary detection outcomes.

Main Results:

3,641 infants met inclusion criteria; 17% developed ROP.
Median PMA for ROP diagnosis was 35.1 weeks; treatment initiation was 40.0 weeks.
FIRST-ROP strategy significantly reduced examinations (estimated 17% fewer visits) without missing TW-ROP cases.

Conclusions:

No infants in this medium-risk cohort required treatment before 34 weeks PMA.
The FIRST-ROP algorithm is validated, supporting safe deferral of initial ROP screening.
Deferring screening to 34 weeks PMA reduces burden while maintaining sensitivity for TW-ROP.