Retinopathy Of Prematurity Screening Guidelines Research Articles

Habilitation services for children blind from retinopathy of prematurity: Health care professionals' perspective in Maharashtra.

Purpose:To explore the knowledge of retinopathy of prematurity (ROP) and habilitation services for children with visual loss from ROP, among health care professionals (HCPs) involved in care of preterm children and to explore their attitudes and practices in relation to referral for habilitation.Methods:A modified knowledge, attitude and practice questionnaire were administered to ophthalmologists and paediatricians associated with ROP care. Data were collected about their knowledge, beliefs and practices of ROP and referral to rehabilitation facilities. Data were analysed to establish level of knowledge, type of attitude and practices and its association with speciality.Results:Response rate was 78% (25/32). Most (14/25, 56%) were ophthalmologists. All (100%) participants knew that ROP can cause blindness. Knowledge about Indian ROP screening criteria was poor among a third (8/25, 32%), more so in paediatricians (5/11, 45.5%). Most (21/25, 84%) did not have knowledge of what a habilitation service entails and where such facilities are located. More than two-thirds (18/25, 72%) believed that special education should be preferred over inclusive education. Overall, 10/25 (40%) of the HCPs had never referred a child for rehabilitation. More than a half (13/25, 52%) were not confident of counselling parents of blind children. All agreed that rehabilitation services are not part of but should be included in medical curriculum.Conclusion:Indian guidelines for ROP screening are not universally known among HCPs. Educating medical undergraduates, providing counselling training to professionals and integration of rehabilitation into the health system will ensure continuity of care for children with visual loss and their families.

Development of Modified Screening Criteria for Retinopathy of Prematurity

Current retinopathy of prematurity (ROP) guidelines, which are based on studies of high-risk infants and expert opinion, have low specificity for disease requiring treatment. Postnatal weight gain-based models improve specificity but have been limited by complexity and small development cohorts, which results in model overfitting and resultant decreased sensitivity in validation studies. To develop a birth weight (BW), gestational age (GA), and weight gain (WG) prediction model using data from a broad-risk cohort of premature infants. The Postnatal Growth and ROP Study was a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada from 2006 to 2012 that included 7483 premature infants at risk for ROP with a known ROP outcome. A hybrid modeling approach was used that combined BW/GA criteria, weight comparison with expected growth from infants without ROP, multiple growth-interval assessments, consideration of nonphysiological WG, and user-friendly screening criteria. Numerous BW/GA levels, postnatal age periods, time intervals, and WG percentile thresholds were evaluated to identify the most robust parameters. Sensitivity for Early Treatment of ROP Study type 1 ROP and potential reduction in infants who require examinations. Of 7483 infants, the median (SD) BW was 1099 (359) g, the median GA was 28 weeks (range, 22-35), 3575 (47.8%) were female, 3615 (48.4%) were white, 2310 (30.9%) were black, 233 (3.1%) were Asian, 93 (1.2%) were Pacific Islander, and 40 (0.5%) were American Indian/Alaskan Native. Infants who met any of 6 criteria would undergo examinations: (1) a GA of younger than 28 weeks; (2) a BW of less than 1051 g; a WG of less than 120 g, 180 g, or 170 g during ages 10 to 19, 20 to 29, or 30 to 39 days, respectively; or hydrocephalus. These criteria predicted 459 of 459 (100%) type 1 (sensitivity, 100%; 95% CI, 99.2%-100%), 524 of 524 (100%) treated, and 466 of 472 (98.7%) type 2 cases while reducing the number of infants who required examinations by 2269 (30.3%). This cohort study, broadly representative of infants who are undergoing ROP examinations, provides evidence-based screening criteria. With validation, the Postnatal Growth and ROP Study criteria could be incorporated into ROP screening guidelines to reduce the number of infants who require examinations in North America.

Screening for retinopathy of prematurity: Trends over the past 5 years in two German university hospitals

The number of preterm births in Germany has been increasing continuously over the past decades. Retinopathy of prematurity (ROP) is amajor complication of preterm birth and one of the leading causes of blindness in children. This study analyzes the development of the incidence of ROP over the past 5 years at two German university hospitals, utilizing data from ROP screening examinations. We assessed all children born in the years 2012-2016 who were included in the ROP screening program at two German university hospitals according to the criteria of the German ROP screening guidelines. Parameters such as gestational age, birth weight, ROP stage and zone, and need for therapeutic intervention were assessed. We analyzed the data of 863 children who had undergone atotal of 4117 screening examinations. The number of children included in the screening program per study year increased continuously over the study period by atotal of 43.1% (137 in 2012, 196 in 2016). Likewise, the number of screening examinations per year increased by 58.4% (608 in 2012, 963 in 2016). Overall, 27.5% of screened infants were diagnosed with ROP of any stage and 2.5% required treatment for ROP. The number of children diagnosed with ROP of any stage per year increased by 100.0% (32 in 2012, 64 in 2016). Mean gestational age (29.0 ± 3.0weeks) and mean birth weight (1192 ± 513 g) remained stable over the study period. Screening data for ROP from two German university hospitals demonstrates asignificant increase in both the number of screened infants and the number of infants affected by ROP over the past 5 years.

Toward Achieving 100% Adherence for Retinopathy of Prematurity Screening Guidelines.

To report on the use of a cloud-based electronic medical record (ROP Check; Glacier Medical Software, Anchorage, AK) designed to provide American Academy of Pediatrics (AAP) guideline-adherent retinopathy of prematurity (ROP) care through the scheduling and documenting of ROP examinations. Data analysis on 3,155 patients from a de-identified dataset from 13 neonatal intensive care units. All newborns with a gestational age of 22 to 30 weeks (N = 2,278) were entered with a documented ROP examination. Of those, 98% and 97.4% completed their initial and follow-up examinations, respectively, within AAP guidelines. All but 1 of 145 initial treatments were completed within AAP guidelines after a decision for treatment was made. Of 369 newborns older than 30 weeks' gestational age and with a birth weight of less than 1,500 grams, none progressed to treatment; four patients had stage 2 or 3 ROP. Of 508 newborns with a gestational age of 31 to 32 weeks and a birth weight of more than 1,500 grams who were entered to identify unstable newborns, 34% did not need examinations; of those who were examined, one progressed to treatment. Fourteen percent of patients were observed as outpatients before retinal maturity and 12% missed some or all outpatient appointments. A decision was made to treat at the first examination for 2 (10%) newborns with a gestational age of 22 weeks and 2 (2%) newborns with a gestational age of 23 weeks. Each patient was within the AAP guidelines for initial treatment. A computerized system specifically designed with process improvement and error-free delivery of ROP care as a focus can improve adherence to AAP guidelines and achieve superior results. Such a system creates a standardized and measurable safety net for pediatric ophthalmologists, neonatologists, hospitals, and follow-up pediatricians. [J Pediatr Ophthalmol Strabismus. 2017;54(6):356-362.].

Retinopathy of prematurity: Improving parental awareness and perceived importance of follow-up eye exams using an informative pamphlet (Interim Report)

BackgroundTreatment of retinopathy of prematurity (ROP) to prevent blindness depends on timely eye exams of at-risk infants. PurposeTo examine the effectiveness of a user-friendly pamphlet in improving parents' perceived importance of and ultimate adherence to ROP screening guidelines. MethodsA pamphlet on ROP was provided to parents of at-risk infants. Before and after reading the pamphlet, the parents were evaluated on their knowledge of ROP and their perception of the importance of timely follow-up screening. ResultsBefore and after pamphlet exposure, the knowledge of ROP essentially stayed the same for all parents. Before pamphlet exposure, a couple of parents chose lower than “Extremely Important” for perceived importance of follow-up eye exams. After pamphlet exposure, all parents chose “Extremely Important” for importance of follow-up. ConclusionProviding a user-friendly pamphlet on ROP to parents of preterm infants could increase the perceived importance of timely follow-up eye exams, thus reducing the rate of potentially preventable blindness.

An evaluation of the screening for retinopathy of prematurity in very-low-birth-weight babies at a tertiary hospital in Johannesburg, South Africa

Background. Retinopathy of prematurity (ROP) is a leading cause of blindness for very-low-birth-weight (VLBW, <1 500 g) babies. ROP screening identifies babies that require treatment to prevent major visual impairment. Objectives. To evaluate the screening for ROP at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) by reviewing the number of babies screened according to the CMJAH guidelines, the grades of ROP found and the treatment modality received. Methods. This was a retrospective record review of VLBW babies born between 1 January 2013 and 31 December 2013 at CMJAH, whether inborn or transferred in. The babies were divided into two groups based on age at final outcome. Final outcome was defined as death, discharge or transfer out of the unit. The ‘early’ outcome group had their final outcome before day 28 of life. The ‘late’ outcome group had their final outcome at day 28 or more of life. The early outcome group qualified for outpatient ROP screening and the late outcome group qualified for inpatient ROP screening. Results. There were a total of 572 VLBW babies at CMJAH during this time period. The babies had a mean birth weight of 1 127 (standard deviation (SD) 244.75) g and gestational age of 29 (2.743) weeks. The mean duration of stay was 29 (21.66) days and there were 309 female babies. Of these 572 babies, 304 comprised the early outcome group and 268 comprised the late outcome group. In the early outcome group babies who were transferred out of the unit or died were excluded; therefore the remaining 147 babies discharged home qualified for outpatient ROP screening. Inpatient ROP screening was carried out in 36/147 (24.4%) of these babies (not in accordance with ROP screening guidelines). ROP was documented in 4/36 (11.1%). Outpatient ROP screening records were unavailable. Exclusions from the late outcome group included five babies. In the late outcome group 111/263 (42.2%) were screened for ROP. ROP was found in 17%. One baby required treatment with intravitreal antivascular endothelial growth factor (VEGF) and three babies required surgery. Conclusions. More than half of the babies in the late outcome group were not screened during their stay (57.8%). More than one-third of babies were discharged prior to reaching the current recommended age for screening. Efforts need to be intensified to identify and screen all eligible babies prior to discharge. Outpatient ROP screening is not well documented; therefore prevalence cannot be established.

The Colorado–retinopathy of prematurity model (CO-ROP): postnatal weight gain screening algorithm

To describe a novel retinopathy of prematurity (ROP) screening model incorporating birth weight, gestational age, and postnatal weight gain that maintains sensitivity but improves specificity in detecting all grades of ROP compared to current 2013 screening guidelines. The medical records of 499 neonates from a single tertiary referral center who met the 2013 screening guidelines for ROP were retrospectively reviewed. Weekly weights were analyzed using standard logistic regression to determine the age at which the weekly net weight gain best predicted the development of ROP, which was designated as the postnatal weight gain criterion. The 2013 birth weight and gestational age criteria were included in an "and" fashion to form the CO-ROP model. Sensitivities and specificities in detecting high grade (type 1 and 2) and all grades of ROP were calculated. The CO-ROP model screens infants with a gestational age at birth of ≤30weeks and birth weight of ≤1500g and net weight gain of ≤650g between birth and 1month of age. In our cohort, CO-ROP had a sensitivity of 100% (95% CI, 92.1%-100.0%) for high-grade (type 1 and 2) ROP and 96.4% (95% CI, 92.3%-98.7%) for all grades of ROP. It would reduce the number of infants screened by 23.7% compared to 2013 guidelines. Calibrating the model to detect only high-grade ROP would result in a 45.9% reduction in the total number of infants screened. CO-ROP is a simple model that maintains a statistically similar sensitivity in detecting all grades of ROP while significantly reducing the total number of required ROP screenings compared to 2013 guidelines. The study had a small sample size but shows promise for future research and clinical efforts.

ANALYSIS OF CHANGES IN CHARACTERISTICS OF SEVERE RETINOPATHY OF PREMATURITY PATIENTS AFTER SCREENING GUIDELINES WERE ISSUED IN CHINA.

To describe the changes in the characteristics of infants treated for severe retinopathy of prematurity (ROP) in a tertiary referral unit in China after screening guidelines were issued in 2004 and to evaluate the effectiveness of the current criteria. Information on consecutive infants referred to a single eye department for treatment of Stage 3 (Type 1 pretheshold and threshold disease), Stage 4, and Stage 5 ROP between January 2001 and May 2012 was retrieved from medical records. The mean gestational age was 29.98 ± 2.13 weeks (range 26-34 weeks), and the mean birth weight was 1,414.32 ± 343.18 g (range 742-2,087 g). The proportion of infants with Stage 4 and Stage 5 ROP decreased statistically significantly over time (P = 0.026 and P < 0.001, respectively) after screening guidelines for ROP were issued in 2004. The median postmenstrual age when patients first visited the study hospital was 48.32 weeks (range 30-602 weeks); later presentation was significantly associated with more advanced ROP (P < 0.001). In addition, the postmenstrual age of first presentation showed a significant decrease over time (P < 0.001) after the screening guidelines were issued. The current Chinese screening guidelines cover 99.63% of infants while 9.07% of infants exceeded the U.K. screening criteria and 35.77% of infants exceeded the U.S. criteria. After the government issued guidelines on ROP screening, the birth weight and gestational age of severe ROP patients remain similar. Big infants got severe ROP as before. But the awareness of ROP increased, the proportion of infants with retinal detachment caused by ROP decreased, and the infants received more timely treatment. The current ROP screening criteria are very effective.

The Specificity of the WINROP Algorithm Can Be Significantly Increased by Reassessment of the WINROP Alarm

Background: Retinopathy of prematurity (ROP) is a sight-threatening disease affecting extremely preterm infants. The introduction of new ROP screening surveillance systems, with higher sensitivity and specificity than established ROP screening guidelines, has the potential to reduce the number of stressful eye examinations in these infants. Objectives: To improve the specificity of the WINROP (Weight, Insulin-like growth factor-I, Neonatal, ROP) surveillance system, identifying extremely preterm infants requiring treatment for ROP. Methods: Two cohorts that had previously been subjected to WINROP analyses were included and reevaluated in this study. The weight at WINROP alarm for extremely preterm infants, born at gestational age <27 weeks, was reevaluated and by establishing ‘safe' WINROP alarm weight limits, an intersample reassessment of WINROP alarm was performed. The two cohorts were as follows: (1) the Extremely Preterm Infants in Sweden Study (EXPRESS) cohort, infants born in Sweden during 2004-2007 (n = 407), and (2) extremely preterm infants in a North American cohort, born during 2006-2009 (n = 566). Results: In the EXPRESS cohort, 12.5% (40/319) of the infants who previously received a WINROP alarm were now reassessed as having no alarm; the specificity of WINROP in EXPRESS increased from 23.9% (86/360) to 35.0% (126/360). In the North American cohort, 15.4% (81/526) were reassessed as having no alarm; the specificity increased from 8.5% (38/447) to 26.6% (119/447). The sensitivity persisted as 97.5% in EXPRESS (45/47) and 98.3% (117/119) in the North American cohort. Conclusions: The specificity of the WINROP surveillance system for extremely preterm infants can be significantly improved by reassessment using the weight at WINROP alarm.

Evaluation of new guidelines for ROP screening in Sweden using SWEDROP – a national quality register

To investigate whether recent Swedish guidelines for Retinopathy of Prematurity (ROP) screening, that is, a gestational age (GA) at birth of <31 weeks (w), are applicable in a new national cohort of prematurely born infants. SWEDROP is a national register for ROP, initiated in 2006. The present paper reports on data from the register on various aspects of screening for ROP in infants born between 2010 and 2011 and compares the results with those for a previously published cohort born between 2008 and 2009. During the study period, 1744 infants were screened for ROP. Mean GA was 28.4 w (22-31), and mean birth weight was 1239 g (382-2615). Screening started at postnatal age (PNA) 5.4 w (0.4-13.3) and postmenstrual age (PMA) 33.8 w (24.9-50.1) Mean number of examinations was 5.4 per infant (1-38). Mild (stages 1-2) and severe (≥ stage 3) ROP was found in 15.4% and 8.7%, respectively. Treatment was performed in 4.2% (73/1744) of the infants, but in none with a GA of 30 weeks or more. The first treatment was performed at a mean PNA and PMA of 12.7 w (7.7-25.4) and 37.4 w (32.1-51.4), respectively. Recently introduced new guidelines for ROP screening in Sweden remain applicable. Reassuringly, in infants born between 2010 and 2011, incidence of ROP, frequency and timing of treatment, frequency and timing of examinations and national coverage of ROP screening remained almost identical to those for a previous cohort from 2008 to 2009. The two SWEDROP cohorts provide a basis for discussion among Swedish ophthalmologists and neonatologists on the question of further lowering the upper screening limit with 1 week.

Prevention of blindness due to retinopathy of prematurity: a national movement.

Retinopathy of Prematurity (ROP) has been a blinding disorder and a preventable cause of childhood blindness. With growing interest in pediatric ophthalmology and vitreo-retinal subspecialty, ROP has become increasingly recognized in India. Recently, with rise in number of children admitted to NICU's across India, there has been an increase in number of preterm babies with ROP due to variable neonatal practices. An effort to prevent the disease was taken up by WHO and Ministry of Health & Family Welfare by conducting workshops across India piloted by R.P. Centre, AIIMS. These workshops have gone a long way in spreading awareness amongst both neonatologists and ophthalmologists in paired sessions. Both neonatologists and ophthalmologists complemented each other, discussed ROP prevention and issued ROP screening and good neonatal care guidelines which were different from the American guidelines. Treatment strategies have also undergone a huge change from cryotherapy and laser to anti-vascular endothelial growth factor (Anti-VEGF) drugs which have shown promising results, although caution is to be taken due to lack of data on long-term safety. Overall impact of these workshops led to inclusion of ROP in priority list of blindness control programme of Government of India. Still, ROP prevention needs integration of both governmental and non-governmental agencies, each sharing the load in a complementing way aiding in downward trends of ROP cases.

Evaluating retinopathy of prematurity screening guidelines for 24- to 27-week gestational age infants

ObjectiveTo determine if current retinopathy of prematurity screening guidelines1 adequately identify treatable ROP in a contemporary cohort of extremely low gestation infants.Study DesignData from the Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial were used. Inborn infants 24 0/7 to 27 6/7 weeks gestational age with consent prior to delivery were enrolled in 2005-2009. Severe retinopathy of prematurity (Type 1 retinopathy of prematurity or treatment with laser, cryotherapy, or bevacizumab) or death was the primary outcome for the randomized trial. Examinations followed then current American Academy of Pediatrics (AAP) screening recommendations, beginning by 31-33 weeks postmenstrual age.2,3Results1316 infants were enrolled in the trial. 997 of the 1121 who survived to first eye exam had final retinopathy of prematurity outcome determined. 137 (14% of 997) met criteria for severe retinopathy of prematurity and 128 (93%) of those had sufficient data (without missing or delayed exams) to determine age of onset of severe retinopathy of prematurity. Postmenstrual age at onset was 32.1 to 53.1 wks. In this referral center cohort, 1.4% (14/997) developed severe retinopathy of prematurity after discharge.ConclusionOur contemporary data support the 2013 AAP screening guidelines for ROP for infants 24 0/7 to 27 6/7 weeks gestational age.1 Some infants do not meet treatment criteria until after discharge home. Post-discharge follow-up of infants who are still at risk for severe ROP is crucial for timely detection and treatment.

Augenärztliches Screening bei Frühgeborenen

Retinopathy of prematurity (ROP) is one of the three leading causes of legal blindness in childhood in developed countries. Adequate screening is one of the most important steps towards successful treatment. During the last decades, international and national guidelines for ROP screening have been continually updated. These guidelines correspond to progress in neonatal care and to a better understanding of the relationship between different neonatal parameters and the risk of developing ROP. The present article surveys ROP classification, the current national and international guidelines and new aspects of ROP screening.

Guideline for the prevention, screening and treatment of retinopathy of prematurity (ROP)

Retinopathy of prematurity (ROP), one of the most common causes of preventable blindness in preterm neonates, is emerging as a 'third epidemic' in middle-income countries including South Africa. This is due to the increasing survival of preterm neonates, insufficient monitoring of oxygen saturation (SaO2) in most centres, and lack of an ROP screening guideline in most neonatal units. To guide the standard of care for SaO2 and ROP screening in preterm neonates weighing <1 500 g. This guideline, endorsed by the United South African Neonatal Association (USANA), the Ophthalmological Society of South Africa (OSSA), and the South African Vitreoretinal Society, was developed by the ROP Working Group of South Africa, comprised of neonatologists, ophthalmologists and paediatricians. All healthcare professionals involved in the care of preterm neonates should be aware of SaO2 and ROP screening guidelines. Mothers should be counselled about the possible complications of prematurity.

Neonatal intensive care unit-specific screening criteria for retinopathy of prematurity

This study investigated the incidence of retinopathy of prematurity (ROP) and its risk factors in a tertiary referral hospital in Taiwan to evaluate the applicability of the ROP screening guidelines published by the American Academy of Pediatrics, American Academy of Ophthalmology, and American Association for Pediatric Ophthalmology and Strabismus in 2006 (2006 guidelines). A pediatric ophthalmologist applied the 2006 guidelines to screen for ROP and to treat with laser photocoagulation in each case. We retrieved all records of premature infants referred for ROP screening at the hospital during 2004 to 2008. Univariate logistic regression analysis was applied firstly to identify factors correlating with stage 3 ROP or with laser treatment, and then those significant (p < 0.05) risk factors were analyzed by multivariate logistic regression. In the 138 male and 118 female premature infants in this study, mean gestation age was 30.8 ± 2.8 weeks, and mean birth weight was 1464.7 ± 434.2 g. The percentage of infants with ROP in at least one eye was 38.7%. Thirty two (12.5%) had ROP stage 3 or higher in at least one eye. Multivariate logistic regression analysis showed that the best predictors of type 1 pre-threshold ROP (requiring laser treatment) were young gestational age, low birth weight and male gender. As medical care of extremely premature infants improves, timely identification and treatment of conditions such as ROP are essential. Although the incidence of ROP in this institute was comparable to that in developing countries and higher than that in developed countries, the 2006 guidelines originally developed for a United States population were still applicable. However, the 2006 guidelines should be modified for a Taiwan population by considering gender.

Knowledge, Attitude Practice Study of Retinopathy of Prematurity amongst Pediatricians attending a Neonatal Ventilation Workshop in South India

Objectives: To assess the knowledge, attitude and practice patterns (KAP) of pediatricians about retinopathy of prematurity (ROP). Methods: We administered a questionnaire to pediatricians, prior to a talk on ROP, in a neonatology ventilation workshop. Questions included finding information about their educational and practicing profile, knowledge of screening guidelines, risk factors for ROP, referral facilities and barriers for referral. Results: A total of 38 pediatricians participated in the study. The mean age of the participants was 35.83 ± 7.2 years, 86.8% of them were men. All participants (100%) knew about the risk factors for ROP. 97.4% (37/38) of the participants knew about the ROP screening guidelines and 68% (26/38) knew about the laser treatment for ROP. Only 29% (11/38) knew the composition of dilating drops to be used for preterm babies and 53% (20/38) had an established referral program for ROP. The barriers for ROP screening expressed by pediatricians, included ‘parents not willing’, by 7/38 of the participants(18.4%); 'unaware of referral facilities' by 6/38 of the participants (15.8%) and ‘too expensive’ by 5/38 of the participants (13.1%). Regarding barriers for ROP screening, ‘parents not willing’ reason was expressed by 18.4% (7/38), ‘unaware of referral facilities’ by 15.8% (6/38) and ‘too expensive’ by 13.1% (5/38) of the participants. Conclusions: The study findings suggest that a large majority of pediatricians at a neonatology ventilation workshop were aware of the science of ROP but had less information of ROP service delivery and treatment modalities. The study suggests the need for creating awareness and close coordination between pediatricians and ophthalmologists to address the barriers for screening and service delivery for ROP. This will facilitate taking the science from books and journals to the bedside of the premature neonates and help in reducing needless blindness due to untreated ROP.

OMIC: A watchful eye on retinopathy of prematurity

Relevance: This workshop will review and discuss hospital-based programs for screening and follow-up of retinopathy of prematurity (ROP). Based on 2006 U.S. birth statistics, 86,523 live births were very pre-term (<32 weeks) and 63,309 live births were very low birthweight (<1500 g). Relying on this data and current American Academy of Pediatrics ROP screening guidelines, one ophthalmologist estimates that there may be as many as 450,000 ROP screening examinations performed in U.S. NICUs each year. These statistics underscore the fact that ROP screening and follow-up are primarily hospital-based. American Hospital Association data indicates that over 1,100 hospitals in the United States have NICUs. Reflecting a commitment to quality of care and patient-safety, some hospitals are adopting a systematic approach, utilizing one central NICU ROP coordinator (ROPC), to ensure that premature infants receive timely ROP screening and follow-up.

Evaluation of modified retinopathy of prematurity screening guidelines using birth weight as the sole inclusion criterion

Purpose:The purpose was to determine if birth weight (BW) alone can be the sole criterion for screening infants at risk for retinopathy of prematurity (ROP).Materials and Methods:In this retrospective, observational case series, 208 infants were screened for ROP using the American Association for Pediatric Ophthalmology and Strabismus (AAPOS) Guidelines (1997). Variables examined included gestational age (GA), birth weight (BW), and a composite variable BWGA Index [(grams × weeks)/1000], which takes into consideration both the birth weight and gestational age of the infant. Infants were divided into two groups: Group 1, BW ≤1250 g, and Group 2, BW >1250 g. Multivariate analysis was performed to detect factors predictive of ROP. Receiver operator characteristic (ROC) curves were generated to determine the efficacy of screening using the BW, GA, and BWGA Index. Statistical analyses were performed with logistic regression with a P-value of 0.05 or less indicating statistical significance.Results:Varying stages of ROP were present in 116 of 416 eyes. Of the 105 eyes in Group 2, only 1 eye developed stage 1 ROP. Only Group 1 eyes developed stage 3 or higher ROP. The ROC curve for BW alone gave an area under the curve (AUC) of 0.797 (standard error [SE] = 0.0329, P < 0.0001); for GA, AUC was 0.801 (SE = 0.0340, P < 0.0001) and for the BWGA Index, the AUC was 0.808 (SE = 0.0324, P < 0.0001). Using 1250-g BW as a criterion for ROP screening would have decreased the number of screenings by 24%, and did not exclude any ROP higher than stage 1.Conclusion:Data from our neonatal intensive care unit suggest that birth weight ≤ 1250 g alone is an adequate parameter to identify premature infants at risk for ROP.

Adopting western retinopathy of prematurity screening programs in eastern countries, are we screening properly?

Purpose:To describe retinopathy of prematurity (ROP) among Jordanian preterm infants and evaluate the efficacy of applying current Western screening guidelines for Jordanian preterms.Materials and Methods:In this retrospective, descriptive hospital-based study, we collected data on preterm infants who were referred by their neonatologist for ROP screening at King Abdullah University Hospital between July 2006 and June 2007. Guidelines suggested by the American Academy of Pediatrics were followed. Additionally, older preterms considered at risk for ROP by the neonatal intensive care unit were screened. Any neonate with stage 1 ROP or higher in either eye was considered a positive case of ROP.Results:Ninety-one preterms were included in the study. The median birth weight was 1390 gm (range,730-1980 gms) and the gestational age ranged from 26 to 35 weeks with 64.8% of preterms ≤ 32 weeks. ROP occurred in 28.6% of all patients, in 20% of infants with birth weight greater than 1500 gms and in 9.4% of preterms with gestational age ≥ 32 weeks. Six patients (6.6%) required laser treatment, two with low birth weight greater than 1250 gm and one was 33 weeks of age. Consanguinity was identified in 19.2% of infants with ROP while consanguinity in infants who did not develop ROP was 1.9%. This difference was statistically significant (P<0.05).Conclusion:ROP occurs in premature infants in Jordan with gestational age above 32 weeks and birth weight above 1250 gm. Future guidelines for screening should incorporate the current study outcomes. A prospective, population-based is required to set national guidelines for ROP screening in the Jordanian population and similarly for different populations worldwide. Consanguinity may play a role in ROP development and further genetic studies may aid in elucidating the pathogenesis of ROP.

Preliminary results of screening of retinopathy of prematurity in Xi'an

To investigate the appropriate criteria for the screening of retinopathy of prematurity (ROP) in Xi'an region and to determine the risk factors for ROP. Screening criteria were established basing on the ROP screening guidelines, implemented by Ministry of Public Health with minor modification. It included newborn infants with birth weight of 2000 g or less, or gestational age of 34 w or less. The results obtained by the present screening criteria were compared with those obtained from the national screening criteria. Gestation age and birth weight between groups of ROP and normal fundus were compared by Student t-test, the ratios of persistent oxygen inhalation were examined by Chi-square test, and the risk factors for ROP were analyzed by Fisher exact test. A P < 0.05 was considered significant. In all the infants examined, 18 cases (36 eyes, 13.43%) developed ROP, including 4 cases (8 eyes) suffering from stage 1, 5 cases (10 eyes) from stage 2 (one was affected in zone II with plus disease), 5 cases (10 eyes) from stage 3 with plus disease, 1 case (2 eyes) from stage 4 A, 1 case (2 eyes) from stage 5, and 2 cases (4 eyes) from regressed stage. In ROP cases, gestation age ranged from 28 to 34 w, (30.58 +/- 1.97) w; birth weight ranged from 880 to 1950 g, (1388.89 +/- 268.39) g. Statistical analysis showed that, the gestation age and birth weight in normal fundus group were (32.56 +/- 2.00) w and (1773.91 +/- 349.73) g respectively, which were higher than group of ROP (gestation age t = 3.90, P < 0.01; birth weight t = 4.45, P < 0.01). The ratios of persistent oxygen inhalation in group of normal fundus and ROP were 59.48% and 61.11% (chi(2) = 0.017, P > 0.05). It was also observed that the ratios of hypoxic-ischemic encephalopathy and placenta abruption in those two groups were 12.07%, 33.33% (P = 0.030) and 0.86%, 11.11% (P = 0.047). Clinical analysis indicated that prematurity, low birth weight, hypoxic-ischemic encephalopathy and placenta abruption were closely related to the occurrence of ROP. On the other hand, if using national screening criteria, only 108 infants in all 134 cases required screening, and all of the ROP cases could be detected with a detection rate at 16.67%. The detection rate of ROP is 13.43% (18/134) in the present study, which is consistent with the results obtained in previous studies in China. The national criteria are appropriate for the ROP screening in Xi'an region. Prematurity, low birth weight and the relative hypoxia are high risk factors for the occurrence of ROP.