New Criteria Improve Prediction of Retinopathy of Prematurity

By Anne Harding

November 27, 2019

NEW YORK (Reuters Health) - New screening criteria for retinopathy of prematurity (ROP) are more sensitive and specific than current guideline criteria, a prospective validation study shows.

"We think we've come up with a system that works even better than what we were doing in multiple respects," Dr. Gil Binenbaum of The Children's Hospital of Philadelphia told Reuters Health by phone.

In the U.S., infants undergo ROP screening if they weigh less than 1,501 grams at birth or have a gestational age (GA) of 30 weeks or younger, Dr. Binenbaum and his team note in JAMA Ophthalmology, online November 14. The subjective criteria of "poor postnatal course" may be used in infants with a higher birthweight (BW) or older GA.

The authors developed screening criteria in the Postnatal Growth and Retinopathy of Prematurity (G-ROP-1) study that incorporated three measures of slow postnatal weight gain (weight gain less than 120 g from age 10-19 days, weight gain less than 180 g from 20-29 days, and weight gain less than 170 g from age 30-39 days); BW and GA cutoffs of 1,501 g and under 28 weeks, respectively; and hydrocephalus.

In the initial retrospective study cohort of more than 7,400 infants from 29 hospitals, the new criteria were 100% sensitive for type 1 ROP and reduced the number of required diagnostic retinal exams by 30%.

In the new study, G-ROP-2, the authors validated the criteria at 41 hospitals in the U.S. and Canada, including 25 hospitals that participated in the earlier study and 16 new hospitals. The validation cohort included almost 4,000 premature infants at risk for ROP and with known ROP outcomes.

A total of 1,643 infants (41.3%) developed ROP. The criteria predicted type 1 ROP in all of the 219 infants who developed it (100% sensitivity), 260 of 264 infants with type 2 ROP (98.5% sensitivity), and treated ROP in 253 of 256 infants (98.8% sensitivity). The G-ROP criteria reduced the number of infants examined by 35.6%.

Current BW and GA criteria were 99.6% sensitive for type 1 ROP, 99.7% sensitive for type 2 ROP and 99.5% sensitive for treated ROP. They reduced the number of infants needing exams by 9.2%.

"The 2 large cohorts studied provide evidence-based screening criteria with higher sensitivity and higher specificity than the currently recommended ROP screening guidelines," Dr. Binenbaum and his team write. "The criteria can be used clinically to potentially reduce the number of infants receiving examinations. We recommend incorporation of the G-ROP screening criteria into national ROP screening guidelines."

Dr. B. Michele Melia of The Jaeb Center for Health Research in Tampa, Florida, who wrote an editorial accompanying the study, told Reuters Health by email, "To find early ROP, premature infants must undergo a series of eye examinations during a critical period of eye development. These examinations are both costly and stressful for these fragile babies. Binenbaum and colleagues have developed criteria to identify the babies at highest risk of getting ROP, so that fewer babies would require the series of examinations, while still being able to find and treat those babies who do develop ROP."

"The study authors acknowledge there are some challenges to be addressed before G-ROP criteria could be implemented, but none of these are insurmountable, and they do not detract from the outstanding performance metrics and reduction in the number of infants requiring screening examinations," she notes in her editorial. "It is time to consider adoption of new ROP screening guidelines in the United States."

SOURCE: https://bit.ly/2Dbv2iy and https://bit.ly/2rkyOUb

JAMA Ophthalmol 2019.

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