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Retinopathy of prematurity in infants weighing 1000-1499 g at birth
1Division of Paediatrics, Royal Women's Hospital, Carlton, Parkville, Australia.
Insights
Routine eye exams for premature infants weighing over 1249g may be unnecessary. This study found low rates of severe retinopathy of prematurity (ROP) and blindness in this group, suggesting a potential to lower screening weight limits.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Current screening guidelines recommend ophthalmological examinations for infants based on birth weight and gestational age.
- Determining optimal screening criteria is crucial for resource allocation and timely intervention.
Purpose of the Study:
- To evaluate the incidence and severity of ROP in infants with birthweights of 1000-1249 g and 1250-1499 g.
- To assess the potential for safely lowering the upper birth weight limit for routine ROP screening examinations.
Main Methods:
- A prospective cohort study was conducted on 1373 surviving infants born between 1977 and 1992.
- Infants were divided into two groups based on birth weight: 1000-1249 g (group 1) and 1250-1499 g (group 2).
- Ocular examinations were performed starting at 2 weeks of age and continued at 2-week intervals.
Main Results:
- In group 1 (1000-1249 g), ROP was detected in 14.6% and severe ROP in 5.0%. 0.8% required surgery, with low rates of permanent visual impairment.
- In group 2 (1250-1499 g), ROP was detected in 6.4% and severe ROP in 0.8%. No infants required surgery, and no blindness occurred.
- No significant difference in ROP rates was observed between inborn and outborn infants.
Conclusions:
- Routine ophthalmological examinations for infants weighing over 1249 g at birth may not be necessary in neonatal units with similar ROP incidence and visual outcomes.
- The findings suggest that the upper weight limit for ROP screening could potentially be lowered, optimizing resource utilization.
Objective:
To review the incidence and severity of retinopathy of prematurity (ROP) in infants with birthweights 1000-1249 g and 1250-1499 g, to establish whether the upper weight limit for routine ophthalmological examination might safely be lowered.
Methodology:
Prospective cohort study of infants born between 1 January 1977 and 31 December 1992 cared for in the neonatal nurseries at the Royal Women's Hospital, Melbourne. Data were retrieved on 1373 infants who survived their initial hospitalization. They comprised 657 with birthweights 1000-1249 g (group 1) and 716 with birthweights 1250-1499 g (group 2). There were 76 outborn infants in group 1 and 97 in group 2; the remaining infants were all born at the Royal Women's Hospital. Ocular examinations commenced at 2 weeks of age, when possible, and at 2-weekly intervals after that.
Results:
In group 1, ROP was detected in 14.6% (96/657) and severe ROP (bilateral stage 3-5) in 5.0% (33/657). Five (0.8%) children required surgical intervention (reaching threshold disease); following surgery, one was legally blind, one had severely impaired vision, and the other three had near-normal vision. Another child was blind; he was born at 28 weeks gestational age with a birthweight of 1170 g, and was transferred to a Level II hospital at 9 weeks chronological age with no detectable retinopathy. He returned 1 year later totally blind with detached retinae (grade 5 ROP). The prevalence of bilateral blindness in this group was 0.3% (2/657). In group 2, ROP was detected in 6.4% (46/716) and severe ROP in 0.8% (6/716). No children required surgery; three were found to be myopic at follow-up but the corrected visual acuity was normal. No children in group 2 were blind. No significant difference was found between the rates of ROP in inborn and outborn infants.
Conclusion:
In neonatal units with similar rates of ROP and visual outcome, routine ophthalmological examination in the neonatal nursery of infants weighing more than 1249 g at birth is probably unnecessary.