Evaluation of modified retinopathy of prematurity screening guidelines using birth weight as the sole inclusion criterion

ABSTRACT

The purpose was to determine if birth weight [BW] alone can be the sole criterion for screening infants at risk for retinopathy of prematurity [ROP]. In this retrospective, observational case series, 208 infants were screened for ROP using the American Association for Pediatric Ophthalmology and Strabismus [AAPOS] Guidelines [1997]. Variables examined included gestational age [GA], birth weight [BW], and a composite variable BWGA Index [[grams x weeks]/1000], which takes into consideration both the birth weight and gestational age of the infant. Infants were divided into two groups Group 1, BW 1250 g. Multivariate analysis was performed to detect factors predictive of ROP. Receiver operator characteristic [ROC] curves were generated to determine the efficacy of screening using the BW, GA, and BWGA Index. Statistical analyses were performed with logistic regression with a P-value of 0.05 or less indicating statistical significance. Varying stages of ROP were present in 116 of 416 eyes. Of the 105 eyes in Group 2, only 1 eye developed stage 1 ROP. Only Group 1 eyes developed stage 3 or higher ROP. The ROC curve for BW alone gave an area under the curve [AUC] of 0.797 [standard error [SE]=0.0329, P<0.0001]; for GA, AUC was 0.801 [SE=0.0340, P<0.0001] and for the BWGA Index, the AUC was 0.808 [SE=0.0324, P<0.0001]. Using 1250-g BW as a criterion for ROP screening would have decreased the number of screenings by 24%, and did not exclude any ROP higher than stage 1. Data from our neonatal intensive care unit suggest that birth weight premature infants at risk for ROP