Evaluating the Utility of Initial Examinations in Retinopathy of Prematurity

Purpose

To assess the utility of the first or second examinations for retinopathy of prematurity (ROP) in a medium-risk cohort of infants and to propose an optimization to the current ROP screening guidelines.

Design

Retrospective consecutive study.

Participants

Infants screened for ROP between January 2017 and August 2023 at 3 different tertiary-level care neonatal intensive care units.

Methods

Analysis of patients who did not meet criteria for microprematurity or nanoprematurity (those born at ≥ 27 weeks and weighing ≥ 800 g).

Main Outcome Measures

The primary outcomes included the rates of ROP and treatment-warranted ROP (TW-ROP), the presence of TW-ROP at the first or second inpatient examinations, the number of inpatient examinations performed before the first ROP diagnosis, and the overall number of inpatient examinations performed.

Results

A total of 2004 neonates were screened for ROP, among whom 1125 (56.1%) met the inclusion criteria. Of those, 237 neonates (21.1%) had ROP. Eleven infants (1.0%) required treatment for active disease. The median postmenstrual age (PMA) at first ROP diagnosis was 35.3 weeks (interquartile range [IQR], 33.7–37 weeks; range, 30.3–46.7 weeks). The median PMA at stage 3 diagnosis was 39.3 weeks (IQR, 38.3–41.2 weeks; range, 35.1–44.4 weeks). The median PMA at first treatment was 39.6 weeks (IQR, 35.8–43.3 weeks; range, 35.3–49.6 weeks). The median number of inpatient examinations was 2.0 (IQR, 1–4 examinations) for traditional screening, 1.0 examination (IQR, 1–3 examinations) after eliminating the first ROP inpatient examination, and 1.0 examination (IQR, 1–2 examinations) after eliminating the first and second ROP examinations (P < 0.001). No patients met type 1 ROP treatment criteria at either the first or second inpatient examination (100% sensitivity for TW-ROP). In this cohort, starting examinations at 34 weeks’ PMA could save 30.6% of inpatient examinations.

Conclusions

In infants not meeting criteria for microprematurity or nanoprematurity, no type 1 ROP was diagnosed at either of the first 2 inpatient examinations. We propose an amendment algorithm (FIRST-ROP) in which ROP examinations start at 34 weeks’ PMA for neonates born at ≥27 weeks gestational age and ≥800 grams.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.