Validation and Feasibility of the Postnatal Growth and Retinopathy of Prematurity Retinal Screening Criteria at a Level IV Tertiary Care Neonatal Intensive Care Unit

Abstract

Objective: Retinopathy of prematurity (ROP) is detected in preterm infants by standardized screening programs, but they have poor sensitivity. The G-ROP algorithm uses weight gain to predict ROP reporting superior sensitivity. Our objective is to a) independently validate the sensitivity of G-ROP criteria for detection of ROP in infants born at >28 weeks’ gestation in a tertiary care unit in the United States; and b) to calculate the cost savings associated with a potential reduction in exams. Design: This is a retrospective analysis of retinal screening exam data, with post-hoc application of G-ROP criteria to determine if G-ROP criteria had acceptable sensitivity and specificity in diagnosing Type 1 and Type 2 ROP. All infants born at > 28 weeks who were screened by current AAO/AAP guidelines at Oklahoma Children’s Hospital at the University of Oklahoma Health Sciences Center, between 2014-2019 were included. Sub-set analysis of infants screened by second tier criteria was performed. Potential cost savings were estimated using frequency of billing codes. Estimate of cost savings was made using the number of infants who could have potentially been spared examination. Results: The G-ROP criteria had 100% sensitivity in detecting type 1 and 87.6% sensitivity in detecting type 2 ROP, which would have reduced infants screened by 50%. All infants in the second tier who would require treatment were detected. A cost saving of 49% was projected. Conclusions: The G-ROP criteria are easy to apply in real-world setting, thus establishing feasibility. The algorithm identified all cases of Type 1 ROP. However, some cases of Type 2 ROP were not detected. The annual savings in hospital exam cost by using these criteria would be 50%. Therefore, G-ROP criteria can safely be used to screen for ROP and may reduce the number of unnecessary exams.