A Standardized Bedside Screening Protocol for Retinopathy of Prematurity

Retinopathy of prematurity (ROP) screening is a time-sensitive, multidisciplinary clinical process that enables early detection of this vision-threatening disease while minimizing examination-related physiologic stress. This article describes a structured bedside workflow for ROP screening, including eligibility assessment, pre-examination preparation, retinal examination, differential diagnosis of uncertain findings, documentation, follow-up planning, referral, and post-examination care. Infants are selected for screening according to gestational age and birth weight criteria, with additional consideration given to clinically unstable infants considered at risk by the neonatology team. Before examination, parent communication, cardiorespiratory monitoring, pharmacologic mydriasis, and comfort measures are performed according to the screening workflow. Retinal evaluation is performed primarily by binocular indirect ophthalmoscopy combined with scleral depression, while adjunctive image documentation is obtained when available and clinically indicated. Examination findings are recorded according to the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), including zone, stage, and plus disease status, to support consistent classification and longitudinal comparison. Follow-up intervals, senior review, and referral for treatment evaluation are then assigned according to predefined decision criteria. This workflow may serve as a practical operational framework for bedside ROP screening in units seeking more uniform documentation and follow-up planning.