title: A clinical prediction model to stratify retinopathy of prematurity risk using postnatal weight gain.
abstract: OBJECTIVE
  To develop an efficient clinical prediction model that includes postnatal weight gain to identify infants at risk of developing severe retinopathy of prematurity (ROP). Under current birth weight (BW) and gestational age (GA) screening criteria, <5% of infants examined in countries with advanced neonatal care require treatment.
  
  
  METHODS
  This study was a secondary analysis of prospective data from the Premature Infants in Need of Transfusion Study, which enrolled 451 infants with a BW < 1000 g at 10 centers. There were 367 infants who remained after excluding deaths (82) and missing weights (2). Multivariate logistic regression was used to predict severe ROP (stage 3 or treatment).
  
  
  RESULTS
  Median BW was 800 g (445-995). There were 67 (18.3%) infants who had severe ROP. The model included GA, BW, and daily weight gain rate. Run weekly, an alarm that indicated need for eye examinations occurred when the predicted probability of severe ROP was >0.085. This identified 66 of 67 severe ROP infants (sensitivity of 99% [95% confidence interval: 94%-100%]), and all 33 infants requiring treatment. Median alarm-to-outcome time was 10.8 weeks (range: 1.9-17.6). There were 110 (30%) infants who had no alarm. Nomograms were developed to determine risk of severe ROP by BW, GA, and postnatal weight gain.
  
  
  CONCLUSIONS
  In a high-risk cohort, a BW-GA-weight-gain model could have reduced the need for examinations by 30%, while still identifying all infants requiring laser surgery. Additional studies are required to determine whether including larger-BW, lower-risk infants would reduce examinations further and to validate the prediction model and nomograms before clinical use.
authors.affiliation: Division of Ophthalmology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, 9-MAIN, Philadelphia, PA 19104, USA. binenbaum@email.chop.edu
authors.forename: Gil
authors.initials: G
authors.lastname: Binenbaum
authors.forename: Gui-shuang
authors.initials: GS
authors.lastname: Ying
authors.forename: Graham E
authors.initials: GE
authors.lastname: Quinn
authors.forename: Stephan
authors.initials: S
authors.lastname: Dreiseitl
authors.forename: Karen
authors.initials: K
authors.lastname: Karp
authors.forename: Robin S
authors.initials: RS
authors.lastname: Roberts
authors.forename: Haresh
authors.initials: H
authors.lastname: Kirpalani
mesh_terms: D001724:Birth Weight; D018450:Disease Progression; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D016015:Logistic Models; D011379:Prognosis; D011446:Prospective Studies; D012178:Retinopathy of Prematurity / Q000175:diagnosis* / Q000453:epidemiology; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015430:Weight Gain