Validation of an IGF1 Screening Method for Retinopathy of Pre-maturity

Alejandro Pérez-Muñuzuri,María José Blanco-Teijeiro,Carolina López-Sanguos,Natalia Mandiá-Rodríguez,María Luz Couce,Olalla López-Suárez

doi:10.3389/fped.2020.615716

Abstract

Retinopathy of pre-maturity (ROP) is a retinal disease that causes arrest of vascularization of the retina and can result in retinal detachment and blindness. Current screening protocols may not be sufficiently accurate to identify all at-risk patients. The aim of this study is to validate a method for improved identification of newborns at risk of ROP. We conducted a prospective clinical trial of pre-term newborns <32 weeks of gestation and/or <1,500 g birth weight during a 6-year period in a tertiary care hospital. We applied our new method based on measurement of insulin-like growth factor 1 (IGF1) levels at 3 weeks of age and the presence of sepsis during the first 3 weeks of life. Our screening protocol allowed exclusion of 121 (79.1%) patients for whom American Academy of Pediatrics (AAP) guidelines recommended screening, had a negative predictive value of 100%, and correctly identified all patients with ROP. Following retrospective assessment of our data based on these findings, we propose further restriction of the current AAP indications for screening to <1,100 g and <28 weeks of gestation in order to improve diagnostic efficacy while ensuring optimal use of restriction of human and material resources.

Highlights

Improvements in management protocols and available therapies have led to increases in both the number and survival of pre-term newborns, and a parallel increase in the prevalence of associated health issues
A peak in the incidence of Retinopathy of pre-maturity (ROP) in 2005–2006 and the very promising prognostic findings of the Early Treatment for ROP Trial [29], prompted us to begin an exhaustive study of the etiology of this disease, and to investigate the diagnostic relevance of insulin-like growth factor 1 (IGF1) levels
The number of pre-term infants of

Summary

Introduction

Improvements in management protocols and available therapies have led to increases in both the number and survival of pre-term newborns, and a parallel increase in the prevalence of associated health issues. One such pathology is retinopathy of pre-maturity (ROP), which can negatively affect subsequent development and limit autonomy in later life. A wide range of factors have been implicated in the etiology of ROP [3,4,5,6,7,8,9,10,11,12,13,14,15], including lower gestational age, low birth weight and postnatal weight gain, ethnicity, oxygen treatment, hypercapnia, concomitant diseases (sepsis, bronchopulmonary dysplasia, intraventricular hemorrhage), acidosis, transfusions, environmental luminosity, anemia, transfusions, erythropoietin treatment, and vaginal delivery. The clearest associations are demonstrated for low gestational age, low birth weight, and oxygen treatment.

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Conclusion