Can a Risk Factor Based Approach Safely Reduce Screening for Retinopathy of Prematurity?
Objective.Current American retinopathy of prematurity (ROP) screening guidelines is imprecise for infants ≥ 30 weeks with birth weights between 1500 and 2000 g. Our objective was to evaluate a risk factor based approach for screening premature infants at low risk for severe ROP.Study Design.We performed a 13-year review from Intermountain Health Care (IHC) data. All neonates born at ≤32 weeks were reviewed to determine ROP screening and/or development of severe ROP. Severe ROP was defined by stage ≥ 3 or need for laser therapy. Regression analysis was used to identify significant risk factors for severe ROP.Results.We identified 4607 neonates ≤ 32 weeks gestation. Following exclusion for death, with no retinal exam or incomplete data, 2791 (61%) were included in the study. Overall, severe ROP occurred in 260 (9.3%), but only 11/1601 ≥ 29 weeks (0.7%). All infants with severe ROP ≥ 29 weeks had at least 2 identified ROP risk factors. Implementation of this risk based screening strategy to the IHC population over the timeline of this study would have eliminated screening in 21% (343/1601) of the screened population.Conclusions.Limiting ROP screening for infants ≥ 29 and ≤ 32 weeks to only those with clinical risk factors could significantly reduce screening exams while identifying all infants with severe ROP.
College of Nursing, University of Utah, Salt Lake City, UT, USA.
K M
KM
Friddle
School of Medicine, Division of Neonatology, University of Utah, Salt Lake City, UT, USA.
B A
BA
Yoder
School of Medicine, Department of Ophthalmology, University of Utah, Salt Lake City, UT, USA.
M E
0000-0002-7270-5670
ME
Hartnett
Intermountain Health Care, Institute for Health Care Delivery Research, Salt Lake City, UT, USA.
E
E
Henry
School of Medicine, Division of Neonatology, University of Utah, Salt Lake City, UT, USA.
R J
0000-0003-1968-7001
RJ
DiGeronimo