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. 2014 Apr;34(4):311-8.
doi: 10.1038/jp.2014.12. Epub 2014 Feb 6.

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

K A Kennedy  1 , L A Wrage  2 , R D Higgins  3 , N N Finer  4 , W A Carlo  5 , M C Walsh  6 , A R Laptook  7 , R G Faix  8 , B A Yoder  8 , K Schibler  9 , M G Gantz  2 , A Das  10 , N S Newman  6 , D L Phelps  11 ; SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations

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

K A Kennedy et al. J Perinatol. 2014 Apr.

Abstract

Objective: To determine whether current retinopathy of prematurity (ROP) screening guidelines adequately identify treatable ROP in a contemporary cohort of extremely low gestation infants.

Study design: Data from the Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial were used. Inborn infants of 24 (0)/7 to 27 (6)/7 weeks gestational age (GA) with consent before delivery were enrolled in 2005 to 2009. Severe ROP (type 1 ROP or treatment with laser, cryotherapy or bevacizumab) or death was the primary outcome for the randomized trial. Examinations followed the then current AAP (American Academy of Pediatrics) screening recommendations, beginning by 31 to 33 weeks postmenstrual age (PMA).

Result: One thousand three hundred and sixteen infants were enrolled in the trial. Nine hundred and ninety-seven of the 1121 who survived to first eye exam had final ROP outcome determined. One hundred and thirty-seven (14% of 997) met criteria for severe ROP and 128 (93%) of those had sufficient data (without missing or delayed exams) to determine age of onset of severe ROP. PMA at onset was 32.1 to 53.1 weeks. In this referral center cohort, 1.4% (14/997) developed severe ROP after discharge.

Conclusion: Our contemporary data support the 2013 AAP screening guidelines for ROP for infants of 24 (0)/7 to 27 (6)/7 weeks GA. 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.

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Figures

Figure 1
Figure 1
Flow diagram of subjects in the original trial and current analysis
Figure 2
Figure 2
Risk of ROP by gestational age at birth (in completed weeks) among all SUPPORT trial infants with known outcome (997 survivors + 223 infants who died)
Figure 3
Figure 3
Postmenstrual and chronological age of onset for severe (Type 1 or treated) ROP (among infants with age of onset determined) by gestational age at birth with 95% confidence intervals (shaded areas)
Figure 4
Figure 4
Postmenstrual and chronological age of “favorable outcome” (vessels to the ora serrata or vessels in Zone III on two consecutive exams) by gestational age at birth
See this image and copyright information in PMC

References

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    1. Palmer EA, Flynn JT, Hardy RJ, Phelps DL, Phillips CL, Schaffer DB, et al. Incidence and early course of retinopathy of prematurity. Ophthalmology. 1991;98:1628–1640. - PubMed

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