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Multicenter Study
. 2018 Sep 1;136(9):1034-1040.
doi: 10.1001/jamaophthalmol.2018.2753.

Development of Modified Screening Criteria for Retinopathy of Prematurity: Primary Results From the Postnatal Growth and Retinopathy of Prematurity Study

Gil Binenbaum  1   2 , Edward F Bell  3 , Pamela Donohue  4 , Graham Quinn  1   2 , James Shaffer  2 , Lauren A Tomlinson  1 , Gui-Shuang Ying  2 ; G-ROP Study Group
Affiliations
Multicenter Study

Development of Modified Screening Criteria for Retinopathy of Prematurity: Primary Results From the Postnatal Growth and Retinopathy of Prematurity Study

Gil Binenbaum et al. JAMA Ophthalmol. .

Abstract

Importance: 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.

Objective: 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.

Design, setting, and participants: 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.

Main outcome and measures: Sensitivity for Early Treatment of ROP Study type 1 ROP and potential reduction in infants who require examinations.

Results: 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%).

Conclusions and relevance: 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.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Figures

Figure 1.
Figure 1.. Mean Daily Weight Gain by Chronological Age of 7483 Infants in the Postnatal Growth and Retinopathy of Prematurity Study
Figure 2.
Figure 2.. Modified Screening Criteria Developed Using Data From the Postnatal Growth and Retinopathy of Prematurity Study
The criteria would be applied by beginning at the lower left hand of the diagram and proceeding in a clockwise fashion around the 6 criteria. If the gestational age (GA) is younger than 28 weeks, then the infant would receive retinal examinations. If the gestational age is 28 weeks or older, the next criterion (birth weight [BW]) would be checked, and so forth. If none of the criteria apply, then the infant would not receive retinal examinations. These criteria should not be used clinically until validated.
See this image and copyright information in PMC

References

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