Validation of an IGF1 Screening Method for Retinopathy of Pre-maturity

Abstract

Retinopathy of pre-maturity (ROP) is a retinal disease that causes arrest of vascularization of the retina and can result in retinal detachment and blindness. Current screening protocols may not be sufficiently accurate to identify all at-risk patients. The aim of this study is to validate a method for improved identification of newborns at risk of ROP. We conducted a prospective clinical trial of pre-term newborns <32 weeks of gestation and/or <1,500 g birth weight during a 6-year period in a tertiary care hospital. We applied our new method based on measurement of insulin-like growth factor 1 (IGF1) levels at 3 weeks of age and the presence of sepsis during the first 3 weeks of life. Our screening protocol allowed exclusion of 121 (79.1%) patients for whom American Academy of Pediatrics (AAP) guidelines recommended screening, had a negative predictive value of 100%, and correctly identified all patients with ROP. Following retrospective assessment of our data based on these findings, we propose further restriction of the current AAP indications for screening to <1,100 g and <28 weeks of gestation in order to improve diagnostic efficacy while ensuring optimal use of restriction of human and material resources.

Keywords: IGF1; pre-term; retinopathy of pre-maturity; screening; validation.

Figure 1

Incidence of ROP in pre-term newborns weighing <1,500 g born in our hospital (2001–2018).

Figure 2

Box plot showing range, quartile 1, quartile 3, and median percentage increase in IGF1 levels between weeks 3 and 5 of life according to ROP grade (p > 0.05, ANOVA).