Evaluation of the WinROP system for identifying retinopathy of prematurity in Czech preterm infants.

Juraj Timkovic,Martina Pokryvkova,Renata Polackova,Petr Masek,Katerina Janurova,Denisa Barinova

doi:10.5507/bp.2016.061

Abstract

Retinopathy of Prematurity (ROP) is a potentially serious condition that can afflict preterm infants. Timely and correct identification of individuals at risk of developing a serious form of ROP is therefore of paramount importance. WinROP is an online system for predicting ROP based on birth weight and weight increments. However, the results vary significantly for various populations. It has not been evaluated in the Czech population. This study evaluates the test characteristics (specificity, sensitivity, positive and negative predictive values) of the WinROP system in Czech preterm infants. Data on 445 prematurely born infants included in the ROP screening program at the University Hospital Ostrava, Czech Republic, were retrospectively entered into the WinROP system and the outcomes of the WinROP and regular screening were compared. All 24 infants who developed high-risk (Type 1 or Type 2) ROP were correctly identified by the system. The sensitivity and negative predictive values for this group were 100%. However, the specificity and positive predictive values were substantially lower, resulting in a large number of false positives. Extending the analysis to low risk ROP, the system did not provide such reliable results. The system is a valuable tool for identifying infants who are not likely to develop high-risk ROP and this could help to substantially reduce the number of preterm infants in need of regular ROP screening. It is not suitable for predicting the development of less serious forms of ROP which is however in accordance with the declared aims of the WinROP system.

Highlights

Retinopathy of prematurity (ROP) is a potentially blinding vasoproliferative disease affecting prematurely born infants
No ROP Type 1 or Type 2 was found among the infants with birth weight over 1500 g and only 1 patient with ROP Type 1 was present in the group with very low birth weight
A similar situation was found when the infants were divided according to their gestation age at birth – only two (1%) very preterm infants developed ROP Type 1 and one developed ROP Type 2 while 11% of infants born before gestational week 29 developed ROP Type 1 and 6% ROP Type 2

Summary

Introduction

Retinopathy of prematurity (ROP) is a potentially blinding vasoproliferative disease affecting prematurely born infants. The degree of prematurity and low birth weight are the principal risk factors for development of the disease, other factors may play a role[1,2,3,4,5,6,7,8,9,10,11,12,13,14]. IGF-1 plays a key role in the development of multiple tissues and affects processes including vascularization. This maternal supplement is missing, which leads to the pathologically low levels of IGF-1 in new-borns[17,21,22]. In the first stage of ROP, low levels of IGF-1 lead to low activation of VEGF and to obliteration of retinal capillary vessels. In the second stage, the levels of IGF-1 are too high and contribute towards the uncontrolled neoangiogenesis[15,17,19,20,21]

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Results

Discussion

Conclusion