Retinopathy Of Prematurity Examinations Research Articles

Preterm refraction and ocular biometry in children with and without retinopathy of prematurity in the first year of life

To determine ocular biometric and refractive profiles of premature children at risk of retinopathy of prematurity (ROP), comparing those who did and did not require laser treatment.In this prospective study, premature infants underwent biometry and refraction with their first ROP examination. Study parameters were assessed again at 3 months, 6 months, and 1 year. The main outcome measures were spherical equivalent, axial length, and keratometry.A total of 122 infants (243 eyes) were included. At baseline, infants without ROP, those with ROP who never needed treatment, and those who later needed treatment had overall comparable axial length (P = 0.53) and myopia (P = 0.05); the highest severity group had higher corneal steepness and more myopia at baseline. At 1 year, children with laser-treated ROP had the shortest axial lengths, with the least decrease in keratometry, and the greatest increase in myopia (-2.0 D; P = 0.001). Anisometropia, if present initially, persisted through the 1-year examination. Mean refractive error was more myopic in zone 1 disease (P = 0.3) and in aggressive posterior ROP (P = 0.15).Severe ROP is associated with disruption of emmetropization, and steeper corneas and more myopia at the first ROP examination, before any intervention. In our study cohort, these differences became more marked over the course of 1 year after laser therapy. The myopia in these cases was not axial. Laser therapy did not induce new anisometropia.

Validation of smartphone-based screening for retinopathy of prematurity in a low-resource setting

To study the validity of smartphone-based screening to detect moderate-to-severe levels of retinopathy of prematurity (ROP) in a low-resource setting. In this observational validation study, all new patients at a single center who met screening criteria for ROP (birth weight of ≤1700g and gestational age of ≤35weeks) were examined by a pediatric ophthalmologist using indirect ophthalmoscopy. At the first ROP examination, a trained photographer captured fundus images using a smartphone fitted on an adapter, the Paxos Scope. The photographs were graded by two retina specialists masked to results of the gold standard examination. A total of 100 children (200 eyes) were included. ROP was detected in 27.4% by indirect ophthalmoscopy, 16% of whom had moderate-to-severe ROP, defined as stage 3 in zone I or II, stage 2 in zone I or II, or pre-plus or plus disease. Sensitivity of fundus images reviewed by grader 1 against the gold standard in detecting moderate-to-severe ROP was 87.5%, and specificity was 82.1%. The positive predictive value was 48.3 %; the negative predictive value, 97.2%. The sensitivity of fundus images reviewed by grader 2 was 87.5%; the specificity, 81.6%. Positive predictive value was 47.5%; negative predictive value, 97.2%. The measured κ coefficient for intergrader agreement was 0.94. Our study is one of the few studies on smartphone-based telescreening for ROP. The results suggest that smartphones may have potential as a screening tool for ROP in low-resource settings.

Systemic adverse events after screening of retinopathy of prematurity with mydriatic.

PurposeTo evaluate systemic adverse events after screening for retinopathy of prematurity (ROP) performed with mydriatic.MethodsThis was a retrospective case series study. Medical records of consecutive patients who underwent screening for ROP with 0.5% phenylephrine and 0.5% tropicamide eyedrops were retrospectively reviewed. The score of abdominal distention (0–5), volume of milk sucked and volume of stool, along with systemic details (pulse and respiration rates, blood pressure and number of periods of apnea) were collected at 1 week and 1 day before ROP examination, and at 1 day after examination. Results were compared between the days before and after examination. Correlation between body weight at the time of examination and the score of abdominal distention was examined. The numbers of infants with abdominal and/or systemic adverse events were compared between pre- and post-examination periods.ResultsEighty-six infants met the inclusion criteria. The score of abdominal distention increased from 2.0 at 1 day before examination to 2.3 at 1 day after examination (p = 0.005), and the number of infants who had worsened abdominal distension increased after examination (p = 0.01). Infants with lower body weight had a higher score of abdominal distention (p < 0.0001, r = −0.57). The number of infants with reduced milk consumption increased after examination (p = 0.0001), as did the number of infants with decreased pulse rate (p = 0.0008).ConclusionsScreening for ROP with mydriatic may have adverse effects on systemic conditions. Infants should be carefully monitored after ROP screening with mydriatic.

Preterm infant stress during handheld optical coherence tomography versus binocular indirect ophthalmoscopy examination for retinopathy of prematurity

Preterm infant stress during handheld optical coherence tomography versus binocular indirect ophthalmoscopy examination for retinopathy of prematurity

Analysis of Adenovirus Conjunctivitis Outbreak in a Neonatal Intensive Care Unit

Objective In this study, it is aimed to present the outbreak analysis of Adenovirus conjunctivitis (AC) that develops associated with medical devices used during retinopathy of prematurity (ROP) examination for retinopathy of prematurity. Materials and Methods In this study; The neonatal AK outbreak that occurred at the Sakarya Training and Research Hospital was retrospectively analyzed. Patient data were obtained from files and infection surveillance records. Bacteriological culture and polymerase chain reaction (PCR) examinations for Adenovirus were performed from the eye swab samples of the patients and ten medical instruments (blepharosta, indirect ophthalmoscope, scleral depressor and 20-28 diopters) used during ROP examination. Results After AK was detected in the eyes of a nurse working in a neonatal intensive care unit (NICU), one inpatient baby and three more babies developed AK. All four babies who developed AK had ROP examination on the same day. It was understood that eye examinations could not be performed with sterile or disposable instruments, disinfection was performed with 10% povidone iodine while passing from one baby's examination to another, and then it was used again in ROP examination. No pathogenic bacteria were grown in the bacteriological culture of eye swab samples. Adenovirus DNA was detected by PCR in eye swab samples of four newborns and nurses and in four devices called blepharosta used for ROP examination. Conclusion AC outbreaks develop in infants hospitalized in the NICU when standard precautions are not followed. Disinfection processes should always be carried out with standardized practices, standards should not be compromised and these practices should be constantly monitored.

The Serum Levels of Asymmetric Dimethylarginine, Vascular Endothelial Growth Factor, and Insulin-Like Growth Factor-1 in Preterms with Retinopathy of Prematurity

Objective: To determine the serum levels of asymmetric dimethylarginine (ADMA), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1) in preterms with retinopathy of prematurity (ROP). Materials and Methods: We included 37 preterm infants. The first blood samples were obtained within the first 5 days of life and repeated at the time of the first ophthalmologic examination for ROP. The levels of ADMA, IGF-1, and VEGF were measured in all samples. Results: ROP was detected in 12 of the subjects (32.4%). We categorized the subjects as non-ROP (Group 1; n = 25), untreated ROP (Group 2; n = 7), and treated ROP (Group 3; n = 5) according to the eye findings. There were no significant differences among the groups for serum levels of ADMA, VEGF, and IGF-1 at the first sampling. Conclusion: We did not find any differences in terms of serum ADMA, IGF-1, and VEGF levels in preterm infants with or without ROP.

Preterm Infant Stress During Handheld Optical Coherence Tomography vs Binocular Indirect Ophthalmoscopy Examination for Retinopathy of Prematurity

Binocular indirect ophthalmoscopy (BIO) examination for retinopathy of prematurity (ROP) is a well-known cause of repeated preterm infant stress. To compare stress during investigational optical coherence tomography (OCT) imaging to that during BIO for ROP. This cross-sectional study examined infants at the bedside in the intensive care nursery. Consecutive preterm infants enrolled in Study of Eye Imaging in Preterm Infants (BabySTEPS) who had any research OCT imaging as part of the study. Patients were recruited from June to November 2019, and analysis began April 2020. Infant stress was measured using modified components of a neonatal pain assessment tool before (baseline) and during OCT imaging and BIO examination of each eye. For 71 eye examinations of 16 infants (mean [SD] gestational age, 27 [3] weeks; birth weight, 869 [277] g), change from baseline to each eye examination was lower during OCT imaging than during BIO and the difference between OCT imaging and BIO at each eye examination was significant for the following: infant cry score (first eye examination: mean [SD], 0.03 [0.3] vs 1.68 [1.2]; -1.65 [95% CI, -1.91 to -1.39]; second eye examination: mean [SD], 0.1 [0.3] vs 1.97 [1.2]; -1.87 [95% CI, -2.19 to -1.54]), facial expression (first eye: 3 [4%] vs 59 [83%]; -79% [95% CI, -87% to -72%]; second eye: 4 [6%] vs 61 [88%]; -83% [95% CI, -89% to -76%]), and heart rate (first eye: mean [SD], -7 [16] vs 13 [18]; -20 [95% CI, -26 to -14]); second eye: mean [SD], -3 [18] vs 20 [20] beats per minute; -23 [95% CI, -29 to -18]) (P < .001 for all). Change in respiratory rate and oxygen saturation did not differ between OCT imaging and BIO. While the role of OCT alone or in combination with BIO is currently unknown for ROP, these findings suggest that investigational OCT imaging of ROP is less stressful than BIO examination by a trained ophthalmologist.

Comparison of Breast Milk and Sucrose in Neonatal Pain Relief and Coping with Stress of ROP Examination Using ALPS-Neo

Background: Examination for retinopathy of prematurity (ROP) is one of the procedures that can be stressful for neonates admitted to a neonatal intensive care unit. This study compared breast milk and sucrose in pain relief and coping with the stress of ROP examination using the Astrid Lindgren and Lund Children’s Hospital Pain and Stress Assessment Scale for Preterm and Sick Newborn Infants (ALPS-Neo). Methods: The present study was carried out on a total of 63 preterm infants (including breast milk group [n=21], sucrose group [n=21], and distilled water group [n=21]). The neonates were given 0.5 ml/kg of breast milk, sucrose, or distilled water 2 min before the examination. The ROP eye examinations were video recorded from 5 min before to 15 min after the examination, and infants’ pain and stress levels were assessed using the ALPS-Neo by two blinded evaluators 5 min before, during, and 5, 10, and 15 min after the examination. Results: No statistically significant differences were observed during the examinations in the mean scores of the ALPS-Neo among the three groups (P>0.05). However, there were statistically significant differences among the three groups after the examinations (p <0.05) and in the mean duration of stress adaptation (p <0.05). The duration of stress adaptation in the breast milk group was 11.4 min on average which was lower than that reported for the other groups. ConclusiConcluConclusion Conclusion: Breast milk was more effective in the reduction of pain and stress after ROP examinations, compared to sucrose or distilled water.

Retinopathy of prematurity screening and risk mitigation during the COVID-19 pandemic

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has significantly disrupted the delivery of healthcare. Although most nonurgent ophthalmology visits at Boston Children's Hospital were canceled, premature infants at risk for retinopathy of prematurity (ROP) still required timely, in-person care during the initial 3-month period of the infection surge in Massachusetts. The purpose of the current study was to report our protocols for mitigating risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between infants and eye care providers and to compare examination rates and results with the same 3-month period in 2019.MethodsDuring the infection surge, we added new infection control measures and strengthened existing ones. Additional personal protective equipment was used, and the number of ophthalmologists rotating in the three high-capacity NICUs we service was limited.ResultsMore infants required ROP examinations during the study period in 2020 than in the same period in 2019, but fewer examinations were performed. There were no cases of missed progression to severe ROP during this time and no known transmission of SARS-CoV-2 between ROP patients and ophthalmology staff.ConclusionsOverall, effective ROP care was safely provided during the COVID-19 pandemic, and contact with this vulnerable population was minimized.

Early angiographic signs of retinopathy of prematurity requiring treatment.

Fluorescein angiography (FA) has been a pivotal tool to study the pathophysiology of retinopathy of prematurity (ROP) in vivo. We examined the course of ROP using FA in order to assess the predictive value of angiographic features. This is an observational retrospective cohort multi-center study of eyes screened for ROP with binocular indirect ophthalmoscope and with FA. All infants undergoing screening examination for ROP who had retinal vasculature limited to Zone I and posterior Zone II vascularization underwent FA between 31 and 34 weeks postmenstrual age. RetCam fundus imaging and video digital fluorescein angiography were performed in the neonatal intensive care units. Masked grading of the FA images was retrospectively conducted by two ROP expert ophthalmologists. Ten criteria that describe retinovascular and choroidal features on FA were used to assess their predictive value for development of treatment-requiring ROP. A total of 98 eyes of 56 patients were included for this study. FAs of eyes of premature infants show a wide range of features either at the junction between the vascular and avascular retina and posteriorly to that. Among the angiographic features evaluated, leakage, shunts and hyperfluorescent lesions at the junction between vascular and avascular zone were predictive of the development of treatment-requiring ROP (p < 0.05), but findings in the posterior vascularized retina were not. FA can add to our understanding of the evolution of vascular abnormalities in the course of ROP and can help predict which eyes will go on to treatment.

Should parents be present during screening examinations for retinopathy of prematurity?

Purpose:To investigate whether parents should be present during screening examinations for retinopathy of prematurity (ROP) by investigating the anxiety levels of parents using two different approaches.Methods:This cross-sectional and two-center study was carried out with the parents at the time of the first ROP screening examination of their premature infants. At one center, the parents accompanied the infants during the ROP examination (Group 1), and in the other center, they did not (Group 2). Anxiety levels were assessed with the State-Trait Anxiety Inventory (STAI), which consists of the State Anxiety (STAI-S) and Trait Anxiety (STAI-T) subscales and a visual analog scale (VAS).Results:A total of 147 parents of 127 infants were included in the study. STAI-T and -S levels were 40.5 ± 8 and 37.9 ± 7.5, respectively, in Group 1 and 39.6 ± 8.1 and 39.4 ± 9.1 in Group 2 before the examination. There were no statistically significant differences in terms of these values between the two groups (P > 0.05). The state anxiety levels increased by an average of 1.7 ± 8 in Group 1 and reached 39.6 ± 10.1 after the examination. In Group 2, these levels decreased by an average of − 2.7 ± 7.5 points to a score of 36.4 ± 10.3. This difference was found to be statistically significant (P = 0.001). A similar pattern was observed in the evaluation of the VAS data.Conclusion:As a preliminary opinion, it may be more appropriate for parents to not participate in screening examinations, but single-center controlled studies are required to confirm the results.

Supportive Interventions to Reduce Pain and Stress During Ophthalmic Examinations for Retinopathy of Prematurity in Premature Infants.

Ophthalmic examinations are a frequent source of pain and stress in premature infants. There is evidence for the use of supportive interventions during infant ophthalmic examinations to reduce pain and stress, but there are no standard recommendations for their implementation. The purpose of this quality improvement project was to implement evidence-based, supportive interventions during ophthalmic examinations in premature infants and evaluate the impact on pain, oxygen saturation, heart rate, bradycardic events, and neonatal stress cues. A preintervention and intervention group design was used. Primary outcomes were pain and oxygen saturation. Secondary outcomes were heart rate, number of bradycardic events, and number of neonatal stress cues. Independent-sample t tests were used to compare means of the measures in the preintervention and intervention groups. Supportive interventions during ophthalmic examinations significantly reduced infant pain (during and after the examination), number of bradycardic events (during and after the examination), and number of neonatal stress cues (before, during, and after the examination). There was also a trend for supportive interventions to decrease pain before the examination. Supportive interventions during ophthalmic examinations are effective in reducing pain, bradycardic events, and neonatal stress cues in premature infants and can be successfully implemented as part of a unit-based protocol. Future research is needed to determine the long-term outcomes associated with supportive interventions during ophthalmic examinations in premature infants.

High-Dose Erythropoietin in Extremely Low Gestational Age Neonates Does Not Alter Risk of Retinopathy of Prematurity

Introduction: The Preterm Erythropoietin (Epo) Neuroprotection (PENUT) Trial sought to determine the safety and efficacy of early high-dose Epo as a potential neuroprotective treatment. We hypothesized that Epo would not increase the incidence or severity of retinopathy of prematurity (ROP). Methods: A total of 941 infants born between 24–0/7 and 27–6/7 weeks’ gestation were randomized to 1,000 U/kg Epo or placebo intravenously for 6 doses, followed by subcutaneous or sham injections of 400 U/kg Epo 3 times a week through 32 weeks post-menstrual age. In this secondary analysis of PENUT trial data, survivors were evaluated for ROP. A modified intention-to-treat approach was used to compare treatment groups. In addition, risk factors for ROP were evaluated using regression methods that account for multiples and allow for adjustment for treatment and gestational age at birth. Results: Of 845 subjects who underwent ROP examination, 503 were diagnosed with ROP with similar incidence and severity between treatment groups. Gestational age at birth, birth weight, prenatal magnesium sulfate, maternal antibiotic exposure, and presence of heart murmur at 2 weeks predicted the development of any ROP, while being on high-frequency oscillator or high-frequency jet ventilation (HFOV/HFJV) at 2 weeks predicted severe ROP. Conclusion: Early high-dose Epo followed by maintenance dosing through 32 weeks does not increase the risk of any or severe ROP in extremely low gestational age neonates. Gestational age, birth weight, maternal treatment with magnesium sulfate, antibiotic use during pregnancy, and presence of a heart murmur at 2 weeks were associated with increased risk of any ROP. Treatment with HFOV/HFJV was associated with an increased risk of severe ROP.

ROP examination of premature babies at an eye hospital referred from urban and semi-urban NICUs.

Retinopathy of prematurity (ROP) is seen in low gestational age (GA) and birth weight (BW) babies leading to retinal vascular damage. Screening of preterm would help in early identification of this, sight-threatening disease. Multiple factors play an important role in planning screening strategies for these preterm. The objective of this study was done to find the differences and the reasons affecting the proportion of ROP distribution between urban and semi-urban regions in North India. In this retrospective, comparative study, all babies referred for ROP examination by paediatricians or other general ophthalmologists between 2013 to 2016 were included in the study. Demographic, clinical and treatment related findings were recorded. Five hundred and fifty eight babies (467: urban and 91: semi urban) were examined for ROP. The mean BW in urban and semi-urban settings was 1348.6 ± 395.21 gm and 1703.77 ± 401.76 gm respectively. The mean GA was 30.99 ± 2.93 weeks and 30.73 ± 2.08 weeks in the urban and semi-urban cohorts respectively. The average time for first ophthalmic examination following birth was 23.82 ± 13.69 (range: 3-77) days in urban and 101.16 ± 238.26 (range: 13- 330) days in semi-urban settings. 94% of the babies completed all screening examination visits. Any ROP was identified in 12% and 33.0% of urban and semi-urban cohorts respectively; Type 1 was detected in 7.5% of urban babies and 24% of semi-urban babies. Proportion of ROP in the urban region was 3 times lesser than the semiurban region. Differences in proportion of babies developing any ROP and Type 1 ROP between semi-urban and urban groups is likely due to selection bias, as a high proportion of semi-urban babies did not attend for examination or failed to complete all the examinations necessary. This was particularly true for females. More needs to be done to increase access to regular, systematic screening of preterm babies within neonatal units.

The Clinical Application of Developmental Care in Retinopathy of Prematurity Eye Examinations

Retinopathy of prematurity (ROP) is a disorder affecting the development of retinal blood vessels in preterm infants. Eye screening examinations are important to the early detection and treatment of ROP. However, several studies have associated eye examinations with pain, stress, and negative physiological effects. Developmental care has been provided as part of neonatal care in recent decades, and some studies indicate that this care positively affects pain scores, stress response, and recovery time during ROP eye screenings. In this article, five elements of developmental care that are applicable for preterm infants undergoing eye examinations for ROP are highlighted and described. These five elements include environmental modifications (e.g., provide a quite environment and dim room lighting), positioning (e.g., offer a nest or positing support and promote the infant to achieve neuromotor development), oxygen delivery (provide adequate oxygen support according to clinical conditions), approach and interaction (e.g., talk softly to infants and gently touch them before the eye examination), and cue-based individual care (e.g., soothe infants, give them a short break or soother based on observations of needs and cue-based behavior). Effectively addressing these five elements may minimize the pain, stress, and energy consumption during ROP eye screenings and provide individualized care that is comfortable, supportive, and promotes the healthy development of preterm infants.

Macular OCT Characteristics at 36 Weeks’ Postmenstrual Age in Infants Examined for Retinopathy of Prematurity

To report our ability to capture,-grade reliably, and analyze bedside macular OCT images from preterm infants and relate OCT findings to biological factors and retinopathy of prematurity (ROP) status at a single time window in the Study of Eye Imaging in Preterm Infants (BabySTEPS). Prospective, observational study. Preterm infants eligible for ROP screening with parental consent for research and a 36 ± 1 weeks' postmenstrual age (PMA) visit. We imaged both eyes of preterm infants with an investigational noncontact, handheld swept-source (SS) OCT at the time of clinical ROP examinations. Macular OCT features and layer thicknesses for untreated eyes of infants at 36 ± 1 weeks' PMA were compared with demographic data and clinical ROP examination performed by experts. Statistical analyses accounted for the use of both eyes of infants. Macular OCT features and layer thicknesses, gender, race or ethnicity, gestational age, birth weight, ROP stage, and plus disease. We captured macular OCT from 169 eyes (1 eye excluded because of prior ROP treatment) at36 ±1 weeks' PMA. The quality of OCT volumes was excellent in 33 eyes (19%), acceptable in 112 eyes (67%), poor in 24 eyes (14%), and unusable in 0 eyes (0%). Macular edema was present in 60% of eyes and was bilateral in 82% of infants with edema. At the fovea, retinal and inner nuclear layer thickness increased with edema severity: 183 ± 36 μm and 51 ± 27 μm in mild (16% of eyes), 308 ± 57 μm and 163 ± 53 μm in moderate (25%), and 460 ± 76 μm and 280 ± 83 μm in severe edema (12%), respectively. With an increase in ROP stage from 0 to 2, the mean ± standard deviation retinal thickness at the fovea increased from 227± 124 μm to 297 ± 99 μm (P < 0.001). The choroid was thinner, 155 ± 72 μm, with preplus or plus disease versus without, 236 ± 79 μm (P= 0.04), whereas retinal thickness did not vary. We demonstrated the reliability of methods and the prevalence of OCT findings in preterm infants enrolled in BabySTEPS at a single time point of 36 ± 1 weeks' PMA. Variations in layer thicknesses in infants at this time point may reflect abnormalities resulting from delay in foveal development that may be impacted by macular edema, ROP, or both.

The Comparative Effect of Multisensory Stimulation and Breast Milk on Intensity of Pain in Premature Infants during Retinopathy Screening Examination

Background: eye examination for retinopathy of prematurity (ROP) examinations is a screening test for which is among painful procedures in neonatal care unit. The aim of this study was to investigate the effect of multisensory stimuli and breast milk on intensity of pain in premature infants during eye examination. Methods: This study is a randomized clinical trial that 90 premature infants were randomly divided into 3 groups included: two intervention groups (1.multisensory stimulation (30 infants), 2.The recipient of the mother’s breast milk (30 infants), and control group (30 infants). pain index score was recorded at 6 times based on Premature Infant Pain Profile (PIPP). Data were analyzed using SPSS software version 20.0. Results: The mean pain score during the eye examination in the control group was significantly higher than two intervention groups (P>0.05. (Both sensory stimulation and breast milk intervention groups reduced the pain score, but the sensory stimulation group reached the baseline score earlier than the breast milk group, so that in 1.5 minutes after the second eye examination, there was a significant difference between the pain scores of the two intervention groups. (p <0.05). Conclusion: According to the results of this study, multisensory stimulation and breast milk both can be used to reduce pain in preterm infants during ROP examinations. Although the effect of multisensory stimulation was slightly greater, but breast milk could be a good alternative to a multisensory stimulation because it is a natural safe and effective analgesic at no cost.

Resilience, anxiety and depression, coping style, social support and their correlation in parents of premature infants undergoing outpatient fundus examination for retinopathy of prematurity

ABSTRACT Retinopathy of prematurity (ROP) has become the main cause of blindness in children. To study resilience, anxiety and depression, coping style and social support and their correlation in parents of premature infants undergoing outpatient fundus examination for ROP, and thereby provide evidence for clinical intervention. Questionnaire surveys were conducted by using General Information Questionnaire, Connor-Davidson Resilience Scale, Self-rating Anxiety Scale, Self-rating Depression Scale, Social Support Scale, and the Simplified Coping Style Questionnaire. The resilience in the parents scored (63.24 ± 12.97) points, which was lower than that of Chinese norm (t = 2.309, P < 0.05). The scores of anxiety and depression were higher than those of Chinese norm (t = 12.592, t = 2.362, both P < 0.05). The score of social support was lower than that of Chinese norm (t = 3.793, p < 0.01). Resilience was negatively correlated with anxiety and depression (r = -0.287, -0.358, both P < 0.01), and positively correlated with coping tendency and social support (r = 0.299, 0.139, both P < 0.05). These findings suggested that the parents have low resilience, high levels of anxiety and depression, and low level of social support. Medical staff should assess and improve their psychological status.

Optimised retinopathy of prematurity screening guideline in China based on a 5-year cohort study

PurposesTo develop an optimised retinopathy of prematurity (ROP) screening guideline by adjusting the screening schedule and thresholds of gestational age (GA) and birth weight (BW).MethodsA multicentre retrospective cohort study was...

Validation of the Retinopathy of Prematurity Activity Scale (ROP-ActS) using retrospective clinical data.

Purpose:The International Neonatal Consortium recently published a proposed retinopathy of prematurity (ROP) activity scale intended for use in clinical trials after validation. The aim of this study was to validate the ROP activity scale (ROP-ActS) in a ROP screened cohort with protocol based collected data by evaluating the ability of the ROP-Act scores to predict ROP treatment. In addition, we aimed to evaluate the scale’s sensitivity characteristic of disease severity by studying association with gestational age (GA) in comparison with conventionally used ROP stage and zone.Methods:A cohort of 535 preterm infants with 3324 ROP examinations with an end-point of ROP treatment or end of screening in Gothenburg, Sweden, was included. Median GA was 28.1 weeks, 47.5% were girls, and 74 (13.8%) infants were treated for ROP. The validation was performed by estimating probabilities for ROP treatment, and by applying logistic and linear regression.Results:The original ROP-ActS was overall well-ordered with respect to ability to predict ROP treatment but could be improved by re-ordering score 3 (zone II stage 1) and 5 (zone III stage 3) based on our clinical cohort data. The modified ROP-ActS was superior to ROP stage and zone in the prediction analysis of ROP treatment. Modified ROP-ActS was more strongly related to GA than currently used ROP stage, but not zone.Conclusion:In the studied cohort, the modified ROP-ActS could better predict ROP treatment compared to ROP stage and zone. Retinopathy of Prematurity Activity Scale (ROP-ActS) had a superior sensitivity characteristic studied through association to GA than conventionally used ROP stage.