Abstract
To evaluate the sensitivity, specificity, and cutoff points for the ROPScore, which is based on cumulative risk factors for the prediction of retinopathy of prematurity (ROP), in a population of very low birth weight (BW) preterm infants in southern Brazil. The medical records of all preterm infants with a very low birth weight ≤1,500 g and/or gestational age ≤32 weeks screened for retinopathy of prematurity in two Brazilian institutions between August 2009 and December 2015 were retrospectively reviewed. ROPScores were calculated using birth weight and gestational age, the use of oxygen therapy with mechanical ventilation, and weight gain proportional to birth weight, as measured at postpartum week six and the need for blood transfusions. The study cohort included 322 infants with a mean birth weight of 1181.8 ± 292.5 g and mean gestational age of 29.5 ± 2.3 weeks. The incidences of any stage of retinopathy of prematurity and severe retinopathy of prematurity were 68.3% and 17%, respectively. ROPScore values ranged from 8.7 to 19.9. The best cutoff point for sensitivity and specificity was 11 for any stage of retinopathy of prematurity and 14.5 for severe retinopathy of prematurity. For any stage of retinopathy of prematurity, the sensitivity and specificity of the ROPScores were 98.6% (95% confidence interval = 97.9%-99.3%) and 35.3% (95% confidence interval= 32.3%-38.3%), with a positive predictive value of 76.6% (95% confidence interval= 74.0%-79.2%) and a negative predictive value of 92.3% (95% confidence interval= 90.6%-94.0%). For severe retinopathy of prematurity, the sensitivity was 100% and specificity was 57.3% (95% confidence interval= 54.2%-60.4%), with positive predictive value of 22% (95% confidence interval= 19.4%-24.6%) and negative predictive value of 100%. The cutoff points correctly identified all infants that developed severe retinopathy of prematurity in this cohort. The ROPScore was useful to identify preterm babies at risk for retinopathy of prematurity. In this population, the ROPScore detected all patients at risk for any stage retinopathy of prematurity and severe retinopathy of prematurity. The ROPScore values in this study were similar to those previously described, thereby successfully validating the ROPScore for early detection of retinopathy of prematurity in very low birth weight preterm infants.
Highlights
Retinopathy of prematurity (ROP) is a proliferative vitreoretinopathy of the retina, which occurs in preterm infants and is a major cause of childhood blindness that can be avoided[1,2]
Over the past 10 years, several tools have been developed to predict the occurrence of retinopathy of prematurity (ROP) based on cumulative risk factors, such as WINROP (Weight, Insulinlike Growth Factor-1, Neonatal, ROP)(13,14), CHOP-ROP (Children’s Hospital of Philadelphia)(15), ROPScore[6], and CO-ROP (The Colorado-ROP model)(16)
Through a less complex algorithm that was more acceptable by the Neonatal Intensive Care Unit (NICU) team, WINROP has been improved to allow for more accurate detection of patients at risk for severe ROP[17]
Summary
Retinopathy of prematurity (ROP) is a proliferative vitreoretinopathy of the retina, which occurs in preterm infants and is a major cause of childhood blindness that can be avoided[1,2]. ROP is a multifactorial disease with the most important risk factors being low birth weight (BW) and low gestational age (GA)(3). Low post natal weight gain (WG) has been determined as an important predictor for the development of ROP[4,5]. The ROPScore is based on cumulative risk factors for ROP and is useful for the early identification of patients who are at a greater risk for the development of ROP[4]. Additional to BW and GA, the ROPScore includes the use of oxygen therapy with mechanical ventilation, WG proportional to BW, as measured at postpartum week six, and the need for blood transfusions in order to identify infants early who are at a higher risk for ROP[6]. The ROPScore, as described by Eckert et al[6] is a relatively simple method, since the information must be submitted only once at postpartum week six
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