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A Standardized Bedside Screening Protocol for Retinopathy of Prematurity
Lili Qian1, Hang Zhou2, Xiaoyu Zheng3
1Department of Women's Health, Women's Hospital School of Medicine Zhejiang University.
Insights
This study outlines a structured bedside workflow for retinopathy of prematurity (ROP) screening, ensuring early detection of this vision-threatening condition. The standardized process improves documentation and follow-up planning for at-risk infants.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatrics
Background:
- Retinopathy of prematurity (ROP) is a leading cause of vision loss in premature infants.
- Timely screening is crucial for early detection and intervention to prevent blindness.
- Existing screening protocols can be variable, impacting consistency and follow-up.
Purpose of the Study:
- To describe a structured bedside workflow for retinopathy of prematurity (ROP) screening.
- To standardize the ROP screening process, from eligibility to post-examination care.
- To enhance documentation and follow-up planning for ROP screening.
Main Methods:
- Developed a structured bedside workflow for ROP screening.
- Included eligibility assessment, pre-examination preparation, retinal examination, and differential diagnosis.
- Utilized binocular indirect ophthalmoscopy with scleral depression and image documentation.
- Recorded findings using the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3).
Main Results:
- The described workflow provides a comprehensive framework for ROP screening.
- Standardized documentation using ICROP3 facilitates consistent classification and longitudinal comparison.
- Predefined decision criteria guide follow-up intervals, senior review, and referral for treatment.
Conclusions:
- This structured bedside workflow offers a practical operational framework for ROP screening.
- Implementation can lead to more uniform documentation and improved follow-up planning.
- The workflow aims to optimize early detection and management of ROP, preserving infant vision.
Abstract:
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.
