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K. M. Connor, C. Löfqvist, E. Engstrom, A.-L. Hård, A. Niklasson, A. Hellström, L. E. H. Smith; Early Weight Gain Predicts Retinopathy in Preterm Infants; A Simple and Efficient Screening Approach. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5726.
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The risk of sight-threatening retinopathy of prematurity (ROP) is now predicted using just gestational age (GA) and/or weight at birth. But only ~10% of infants below the GA/weight threshold screened with fundus examinations are found to need treatment. We sought to evaluate if factoring in postnatal weight gain could identify infants at risk for sight-threatening ROP more specifically and earlier.
From 354 infants born before GA 32 weeks and screened and/or treated for ROP at Sahlgrenska University Hospital between 2004-2007, weekly weights from birth to postmenstrual week 36 were retrospectively collected and entered into a surveillance system (WINROP) designed to predict sight-threatening ROP. With this system there are three possible outcomes; the child is predicted to be at no risk or receive an alarm indicating the infant at being either at low risk or high risk of developing sight-threatening ROP. Infants who receive an alarm of low risk before reaching postmenstrual age 32 weeks are considered at high risk and relabeled. One child was excluded due to known nonphysiological weight gain (shunt-treated hydrocephalus).
WINROP designated 36% (127/353) of infants at no risk and 40% (141/353) at low risk (>PMA 32 weeks). None of these infants developed ROP requiring treatment. In the remaining 24% (84/353) designated as high risk, 41% developed proliferative ROP and 29% were treated due to sight-threatening disease. The WINROP algorithm detected early 100% of infants who developed ROP requiring treatment and correctly predicted the majority who did not require treatment. The median time from alarm to treatment was 9 weeks.
The WINROP algorithm predicted early 100% of infants who developed ROP requiring treatment and correctly predicted the majority who did not require treatment. With this simple postnatal evaluation, costly and stressful eye examinations may be markedly reduced (by~75%). In addition, early identification of children at risk may lead to the initiation of interventions and possibly prevent sight-threatening ROP. However, before new screening guidelines can be constructed further validation of the surveillance system has to be performed on other populations of infants.
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