Identifying Premature Infants at Lowest Risk of Developing any ROP
Graham E. Quinn, MD, MSCE; Kelly C. Wade, MD, PhD, MSCE; Gui-shuang Ying, PhD; Agnieshka Baumritter, MS; Alice Gong, MD; Alex R. Kemper, MD, PhD
Children’s Hospital of Philadelphia, University of Pennsylvania
Introduction: According to current AAP guidelines, a subset of very premature infants unlikely to require treatment for severe ROP must undergo fundus examinations after hospital discharge/transfer. We identify characteristics that predict at-risk infants who will not develop ROP by hospital discharge/transfer.
Methods: Secondary analysis of ROP examination data from infants enrolled in the e-ROP study.(1) We characterized infants without ROP during eye examinations at a given postmenstrual age (PMA) (noROPvisit) and those without any ROP at all examinations prior to study endpoint or hospital discharge/transfer (noROPhistory).
Results: 1257 infants with BW <1251 grams underwent 4113 ROP study examinations between 31-47 weeks PMA including 1553 (38%) examinations that showed no ROPpresent. 456 (36%) of all infants demonstrated noROPhistory on examinations prior to study endpoint/discharge/transfer. Among 247 infants born at 27-33 week GA, 237 (96%) did not receive treatment for ROP and 122 (49%) had noROPhistory. No infant with noROPhistory by >37 weeks PMA underwent treatment for ROP. In multivariable analysis, larger BW (>750g) and older GA (>28 weeks) both demonstrated more than 4-fold increased odds of noROPhistory (p<0.01).
Discussion: Absence of ROP on hospital examination in older PMA infants can further identify infants at lowest risk of developing severe ROP and potentially risk adjust the need for ongoing examinations.
Conclusion: Efforts to determine which infants will not develop ROP in a larger sample could provide insight into ways to minimize low-yield eye examinations, thereby reducing the burden for infants and families after the infant is discharged, and allowing focus of scarce resources on high risk infants.
References: 1) Quinn GE, Ying GS, Daniel E, Hildebrand PH, Ells A, Baumritter A, Kemper AR, Schron E, Wade K, for the e-ROP Cooperative Group. Validity of a Telemedicine System for the Evaluation of Acute-Phase Retinopathy of Prematurity. JAMA OPHTHALMOLOGY 132:1178-84, 2014.