Can screening for retinopathy of prematurity be reduced?
BACKGROUND
As screening for retinopathy of prematurity (ROP) is costly, time-consuming for the ophthalmologist and discomforting for the neonate, the minimum number of infants should be screened for ROP, without missing infants with severe ROP, at risk for threshold ROP.


OBJECTIVE
To develop a diagnostic screening guideline for ROP that would safely reduce the number of ROP screening funduscopies in our department.


METHODS
Data of 275 infants admitted between 1996 and 2000 and screened for ROP according to our Dutch National guideline were studied. Significant risk factors for ROP were calculated, using logistic regression analysis and used to develop a guideline. The discriminative power of the guideline was evaluated using the area under the curve for the receiver operating characteristic curve.


RESULTS
Significant risk factors for ROP were: gestational age, birth weight and number of erythrocyte transfusions within the first 4 weeks of life. The combination of these 3 factors resulted in the highest area under the curve: 0.793. Using these 3 factors, a diagnostic screening guideline for ROP was developed: if birth weight + 2 x (gestational age - 20) - 6 x erythrocyte transfusion value within the first 4 weeks of life >or=34, no screening for ROP is necessary. Using this guideline, 22.2% of the infants of the study group could have been excluded from screening; 3.8% of the infants with ROP stages 1-2 would have been missed.


CONCLUSIONS
In our department, ROP screening can be safely reduced using our diagnostic screening guideline.
Termote
J U M
JU
Department of Neonatology, Wilhelmina Children's Hospital/University Medical Center, Utrecht, The Netherlands. J.Termote@wkz.azu.nl
Donders
A R T
AR
Schalij-Delfos
N E
NE
Lenselink
C H
CH
Derkzen van Angeren
C S
CS
Lissone
S C J L
SC
Cats
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BP
D001724:Birth Weight; D017707:Erythrocyte Transfusion; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D015997:Neonatal Screening; D012178:Retinopathy of Prematurity / Q000175:diagnosis* / Q000628:therapy; D012307:Risk Factors