Validation of the Postnatal Growth and Retinopathy of Prematurity modified criteria in Latin American infants

Abstract

Purpose : To evaluate the performance of the Postnatal Growth and Retinopathy of Prematurity (G-ROP) modified screening criteria in Latin America. The G-ROP criteria demonstrated greater sensitivity and specificity for predicting severe ROP than conventional ROP guidelines in the US and Canada. However, characteristics of infants with severe ROP differ in middle-income countries, and prior growth models have not performed well in such settings.

Methods : Secondary analysis of a prospective cohort study of infants screened for ROP between 2012-2014 in Guadalajara, Mexico and La Plata, Argentina. The G-ROP criteria were applied with a single, conservative weight gain threshold of 180g. Babies meeting one or more of the following criteria would receive examinations: gestational age (GA) <28wks; birth weight (BW) <1051g; weight gain<180g during postnatal ages 10-19, 20-29, or 30-39 days; or hydrocephalus. Primary outcomes were sensitivity for severe ROP (Type 1, 2, or treated) and reduction of infants receiving ROP examinations. An a priori plan was made to update the model if sensitivity was not maintained at 100%.

Results : Among 112 infants studied (median BW 1413 (range 620-2390) g; median GA 33 wks (range 25-37)), the G-ROP criteria correctly predicted 16/19 babies with severe ROP (sensitivity, 84.2%; 95% CI, 60.4%-96.6%), while decreasing babies qualifying for examinations by 33.9% (95% CI, 25.8%-43.1%). When updated, with the weight gain threshold set at <210 g for any of the three 10-day periods, sensitivity increased to 100% (95% CI, 82.4%-100%) and the reduction in babies qualifying for examinations was 27.7% (95% CI, 20.2%-36.6%).

Conclusions : The G-ROP criteria initially exhibited poor sensitivity for severe ROP. With updating, it was possible to achieve 100% sensitivity and maintain a significant benefit of fewer babies requiring examinations. However, the lower CI boundary for sensitivity was low, and excessive oxygen use may still prove to be a confounding factor. Therefore, the updated criteria need to be evaluated in a much larger validation study before they could be used clinically.

This is a 2020 ARVO Annual Meeting abstract.