Net Weight Gain from Birth to Time of First Retinopathy of Prematurity (ROP) Examination as Sole Inclusion Criteria for Screening Examinations for ROP

Abstract

 

Purpose

 

Poor postnatal weight gain in premature infants has previously been associated with increased incidence of complications associated with prematurity and ROP. The purpose of this study was to determine the utility of net weight gain (NWG) between birth and time of first ROP screening examination as a predictor for developing ROP.

 

Methods

 

An Institutional Review Board (IRB) approved retrospective chart review was performed on all premature infants who underwent ROP screening examinations between June 2008 and December 2011 at a tertiary referral system’s neonatal intensive care units. Infants who did not complete the entirety of their ROP examinations within our healthcare system were excluded. Birthweight, weight at date of first ROP screening examination, and findings at each ROP examination until retinal maturation were recorded.

 

Results

 

428 infants met the inclusion criteria. 29 infants developed Type 1 ROP, and 100 infants developed Type 2 ROP. Excluding any infants with greater than 700g NWG at first ROP examination did not result in any missed cases of Type 1 ROP (Sensitivity = 1.0, 99%CI 0.84-1.0) . 1 infant with Type 2 ROP was missed. There was no statistical difference in the sensitivity in detecting Type 2 ROP between standard criteria (1.0, 99% CI 0.95-1.0) and the 700g NWG criteria (0.99, 99% CI 0.96-1.00) while improving the relative specificity (0.15, 99% CI 0.10-0.21) of ROP examination compared to standard criteria (0.0, 99% CI 0.0-0.018).

 

Conclusions

 

Our findings suggest that it may be feasible to use 700g NWG as a sole criteria for identifying premature infants for ROP screening examinations. Using the 700g NWG criteria at our institution would have eliminated 11% of normal exams without missing any cases of Type 1 ROP. By extrapolating the proportional reduction in examinations using the 700g NWG criteria to national estimates on the number of infants examined for ROP and estimating the cost equivalent using the 2012 Colorado Medicaid fee schedule, this would incur a cost savings of approximately $6 million dollars annually in the United States.

 

 

Distribution of infants by highest grade of ROP on any screening examination by gestational age (GA) and net weight gain at the time of first ROP Exam. No infants with type 1 ROP were missed using 700g NWG or less as screening criteria. A) Type 1 ROP. B) Type 2 ROP. C) No ROP.

 

Keywords: 706 retinopathy of prematurity