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Retinopathy of prematurity: incidence report of outliers based on international screening guidelines.

ABSTRACT: Aim:The objective of this study is to report the incidence of retinopathy of prematurity (ROP) outliers that fall outside the screening guidelines of the American Academy of Ophthalmology (AAO) in our country. Methods:A retrospective review of 503 records of newborns evaluated in our institution between January 2011 and March 2017. We analyzed the data by subgroups based on gestational age (GA), birth weight (BW) and stage, focusing on the outliers that don't meet the criteria of the screening AAO guidelines (GA???30 weeks, BW???1500 g). Results:Of the 503 records, 352 had some degree of ROP, 91.76% being bilateral, and 26.2% require treatment. The mean GA at delivery was 30.56?±?2.33 weeks, and the mean BW was 1287.90?±?338.52 g. For the current AAO/AAP ROP screening, 19.9% were outliers, of which (57%) had ROP diagnosis and (38%) required treatment. Conclusions:ROP diagnosis in newborns of BW?>?1500 g or GA?>?30 weeks is not uncommon in Mexico, and it is important to take this into account to adjust the selection criteria on each population to reach all the infants at risk.

SUBMITTER: Romo-Aguas JC

PROVIDER: S-EPMC6907106 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Retinopathy of prematurity: incidence report of outliers based on international screening guidelines.

Romo-Aguas Juan Carlos JC González-H León Ana A Meraz-Gutiérrez Miroslava Paolah MP Martínez-Castellanos María A MA

International journal of retina and vitreous 20191212 Suppl 1

<h4>Aim</h4>The objective of this study is to report the incidence of retinopathy of prematurity (ROP) outliers that fall outside the screening guidelines of the American Academy of Ophthalmology (AAO) in our country.<h4>Methods</h4>A retrospective review of 503 records of newborns evaluated in our institution between January 2011 and March 2017. We analyzed the data by subgroups based on gestational age (GA), birth weight (BW) and stage, focusing on the outliers that don't meet the criteria of ...[more]

PMID: 31890290

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Project description:ImportanceThe Colorado Retinopathy of Prematurity (CO-ROP) model uses birth weight, gestational age, and weight gain at the first month of life (WG-28) to predict risk of severe retinopathy of prematurity (ROP). In previous validation studies, the model performed very well, predicting virtually all cases of severe ROP and potentially reducing the number of infants who need ROP examinations, warranting validation in a larger, more diverse population.ObjectiveTo validate the performance of the CO-ROP model in a large multicenter cohort.Design, setting, participantsThis study is a secondary analysis of data from the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study, a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada between January 2006 and June 2012 of 6351 premature infants who received ROP examinations.Main outcomes and measuresSensitivity and specificity for severe (early treatment of ROP [ETROP] type 1 or 2) ROP, and reduction in infants receiving examinations. The CO-ROP model was applied to the infants in the G-ROP data set with all 3 data points (infants would have received examinations if they met all 3 criteria: birth weight, <1501 g; gestational age, <30 weeks; and WG-28, <650 g). Infants missing WG-28 information were included in a secondary analysis in which WG-28 was considered fewer than 650 g.ResultsOf 7438 infants in the G-ROP study, 3575 (48.1%) were girls, and maternal race/ethnicity was 2310 (31.1%) African American, 3615 (48.6%) white, 233 (3.1%) Asian, 40 (0.52%) American Indian/Alaskan Native, and 93 (1.3%) Pacific Islander. In the study cohort, 747 infants (11.8%) had type 1 or 2 ROP, 2068 (32.6%) had lower-grade ROP, and 3536 (55.6%) had no ROP. The CO-ROP model had a sensitivity of 96.9% (95% CI, 95.4%-97.9%) and a specificity of 40.9% (95% CI, 39.3%-42.5%). It missed 23 (3.1%) infants who developed severe ROP. The CO-ROP model would have reduced the number of infants who received examinations by 26.1% (95% CI, 25.0%-27.2%).Conclusions and relevanceThe CO-ROP model demonstrated high but not 100% sensitivity for severe ROP and missed infants who might require treatment in this large validation cohort. The model requires all 3 criteria to be met to signal a need for examinations, but some infants with a birth weight or gestational age above the thresholds developed severe ROP. Most of these infants who were not detected by the CO-ROP model had obvious deviation in expected weight trajectories or nonphysiologic weight gain. These findings suggest that the CO-ROP model needs to be revised before considering implementation into clinical practice.

Project description:ImportanceThe current guidelines for retinopathy of prematurity (ROP) detection programs in the United States include a range of birth weights (BWs) and gestational ages and likely require examinations of many premature infants who are at low risk for developing serious retinopathy.ObjectiveTo determine the incidence, onset, and early course of ROP in what to our knowledge is the largest cohort to date that is representative of infants who are undergoing ROP screening.Design, setting, and participantsThis secondary analysis of data from the Postnatal Growth and Retinopathy of Prematurity (G-ROP) retrospective cohort study was conducted in 29 hospitals in the United States and Canada between January 2006 and December 2011 and included 7483 infants who underwent serial ROP examinations.Main outcomes and measuresMost severe ROP in either eye, classified as no ROP, mild ROP, type 2 ROP, or type 1 ROP (per Early Treatment for ROP Study criteria). Onset at postmenstrual age for zone I disease and stage of ROP, plus disease, and treatment.ResultsThis study included 7483 infants with a mean (SD) BW of 1099 (259) g and a mean (SD) gestational age of 28 (3) weeks who underwent ROP examinations. Of these, 3224 infants (43.1%) developed ROP, 459 (6.1%) developed type 1 and 472 (6.3%) type 2 ROP, 514 (6.9%) underwent treatment in 1 or both eyes, and 147 (2%) had zone I disease. Additionally, 98.1% of type 1 or 2 ROP cases occurred in infants with a BW of less than 1251 g. Only about half of the eyes (49.4%) were vascularized into zone III by 37 weeks postmenstrual age.Conclusions and relevanceThese findings add to our knowledge of ROP screening as they include all eligible infants, not just high-risk infants as in previous studies. More than 40% of at-risk premature infants develop some stage of ROP, and most retinopathy regresses without treatment. However, approximately 12.5% develop severe ROP, which occurs almost exclusively among infants with a BW of less than 1251 g.

Dataset Information

Retinopathy of prematurity: incidence report of outliers based on international screening guidelines.

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Retinopathy of prematurity: incidence report of outliers based on international screening guidelines.

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