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[Optimal (screening) time for detection of therapy-relevant stages of retinopathia praematurorum]
1Augenklinik und Poliklinik, Universität Ulm.
Insights
Early screening for retinopathy of prematurity (ROP) is crucial. For premature infants under 1500g, the first eye exam should be at 32-34 weeks postmenstrual age to detect ROP requiring therapy.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatric Medicine
Context:
- Retinopathy of prematurity (ROP) screening aims to identify infants needing therapeutic intervention.
- Timely and reliable detection of ROP stages requiring treatment is essential.
- Optimizing examination frequency minimizes unnecessary procedures while ensuring ROP detection.
Purpose:
- To determine an optimal time point for the initial ophthalmological examination for retinopathy of prematurity.
- To evaluate the onset of ROP stages requiring therapy in relation to postnatal and postmenstrual age.
- To reduce unnecessary examinations in very premature infants without compromising ROP detection.
Summary:
- A study of 343 premature infants (1987-1991) found severe ROP stages only in those with birth weights ≤1500g.
- ROP stage 2 and 3 onset occurred between 4-24 and 4-20 weeks postnatally, respectively.
- Postmenstrual age is a more reliable indicator for ROP onset; screening at 32-34 weeks postmenstrual age is recommended.
Impact:
- Establishes a specific postmenstrual age for the first ROP screening, improving diagnostic efficiency.
- Allows for avoidance of unnecessary examinations in very immature infants.
- Enhances the reliability and timeliness of ROP detection for infants requiring therapy.
Abstract:
Screening tests for retinopathy of prematurity (ROP) focus on the detection of children in whom the progression of ROP may require therapy. The stages needing therapy must be detected reliably and in time. The frequency of examinations should be limited to the amount needed. We tried to determine whether or not there is a specific time point that can be recommended for the first examination. From 1987 to 1991 we examined 343 children who had been premature or term babies. Only among the 178 immature children with a birth weight of < or = 1500 g were severe stages of ROP found. Of 51 children, 1 child (2%) with a birth weight of between 1500 and 1250 g showed ROP stage 3; 4 children had ROP stage 2 (8%). The birth weight was under 1250 g in 127 prematures. Among these children, ROP progression to stage 2 was found in 119 (15%) and stage 3 in 9 (7%) cases. Independent of the highest stage, stage 2 first occurred 4-24 weeks postnatally, stage 3 between 4 and 20 weeks postnatally. If the highest stage did not occur before menstruation age, stage 2 did not occur before week 34 and stage 3 not before 35 weeks. In comparison to the postnatal age, calculation based on the postmenstrual age allows better individual comparability regarding the onset of ROP stages requiring therapy. Our results suggest that the first ophthalmological examination should be between 32 and 34 weeks after the start of menstruation. Unnecessary examinations of very immature children can be avoided without missing the development of ROP requiring therapy.