Severe retinopathy of prematurity: longitudinal observation of disease and screening implications

Abstract

Purpose To test the effectiveness of our Canadian retinopathy of prematurity (ROP) screening guidelines as applied to high-risk premature infants. Study Design Retrospective longitudinal cohort study. Subjects A total of 969 infants were examined longitudinally between 1991 and 2000 and 46 of these infants screened were treated for severe ROP. Methods Data from weekly ROP screening examination results were collected from a geographical area and analysed. Results The average incidence of severe ROP requiring treatment in the population of premature infants eligible for screening was 48.3 per 1000. In all, 46 infants were treated in this cohort. The mean gestational age (GA) was 25.5 weeks of age and the mean birth weight was 750 g. The mean chronological age (CA) and postmenstrual age (PMA) at the time of first screening was 36 days and 30.7 weeks, respectively. The first identification of any ROP in this group was at a mean CA 60 days and PMA of 34.1 weeks. The mean CA and PMA of the first observation of stage 3 were 74 days and 36.3 weeks. The mean CA and PMA at the time of treatment were 86 days and 37.7 week. Conclusions Our observations and analysis indicate the following ROP screening recommendations: infants of 28 weeks of GA or less, infants with a GA between 28 weeks and 30 weeks should have a single 'spot examination' at approximately 37 weeks of PMA (or prior to discharge from hospital) to include possible outliers; infants born with a birth weight of 1250 g or less; initial screening examination should be at 31 weeks of PMA or 4 weeks of CA, whichever is later; in the presence of any active ROP, the infant should be followed every 1-2 weeks; and stage 3 should be followed at least every 7 days.

Preclinical Screening for Retinopathy of Prematurity Risk Using IGF1 Levels at 3 Weeks Post-Partum

“…It may be anticipated that universal examination of premature babies of birthweight < 1250 g and/or gestational age at birth of < 30 weeks, together with tailored investigations in individual at-risk patients, identified principally using the screening curves such as those that we have shown here, will optimise available resources while at least maintaining current levels of identification and treatment of ROP [20],[21],[22],[23],[24]. In the same context, the most recent guidelines of the American Academy of Paediatrics recommend the restriction of universal screening to newborn babies of less than 30 weeks gestational age, although maintaining the birthweight cut-off at 1500 g [11].…”

Retinopathy of Prematurity: An Optimum Screening Strategy

“…In a recent Canadian study, Ells et al recommend that GA less than or equal to30 weeks should have a single spot examination at 37 weeks' postmenstrual age (PMA) and if BW is 1250 g or less, they should be screened at 31 weeks' PMA. 13 Avoiding unnecessary screening not only reduces parental anxiety but also reduces stress in preterm infants; infants display significantly increased neurobehavioral activity and crying during ROP screening. 14 Rarely, ROP screening can cause potential life-threatening emergencies, such as cardiorespiratory arrest, oxygen desaturation, severe bradycardia, and apnea, in smaller preterm babies.…”

A New Risk-Based Screening Criterion for Treatment-Demanding Retinopathy of Prematurity in Denmark

“…10,12,[26][27][28][29] The conventional screening criteria currently are the main choice. 20,26,[30][31][32][33][34] However, recently 2 new diagnostic screening guidelines have been suggested as effective alternatives.…”

“…30,31 All these criteria resulting from retrospective studies are defining effectiveness as a screening load associated with the number of detected advanced ROP cases and safety as the percentage of all advanced ROP cases detected by a given criterion. 10,12,[26][27][28][29][35][36][37] In this study, effectiveness is defined as the screening load associated with the number of expected missed TD-ROP cases, with the expected number of missed TD-ROP cases being an independent indicator of safety. To our knowledge, no previous studies have evaluated screening criteria based on such measures.…”