Screening premature infants for retinopathy of prematurity in a tertiary hospital in Saudi Arabia

Abstract

BACKGROUND: Early detection of retinopathy of prematurity (ROP) in preterm infants is critical, especially with advancements in neonatal care and improved survival rates. However, a balance should be found between not missing any ROP requiring treatment and minimizing workload, saving resources, and reducing unnecessary examinations to fragile neonates. OBJECTIVE: Ascertain whether our current inclusion criteria in screening ROP could be modified to ≤1250 g (while keeping the gestational age at ≤30 6/7 weeks) to reduce the number of screened babies without missing any type I ROP requiring treatment. DESIGN: Retrospective, record-based study. SETTING: Referral center. MAIN OUTCOME MEASURES: ROP outcome and risk factors. PATIENTS AND METHODS: Neonates screened for ROP in the neonatal intensive care unit of our institution between January 2016 and November 2018 were included. Data collected for each neonate included demographics, ROP details and risk factors. We used a revised version of ROP screening guidelines by the American Academy of Pediatrics. SAMPLE SIZE AND CHARACTERISTICS: 155 neonates (median birth weight, 1035 g; range, 527–1982 g; and gestational age range, 23–39 weeks). RESULTS: Of 1393 live births, 155 babies met the inclusion criteria. ROP occurred in 60/155 (38.7%) screened babies while sixteen developed threshold ROP. All 16 babies who required treatment had both a birthweight ≤1000 g and a gestational age of ≤30 weeks. Using the screening recommendations of the Canadian Policy, more infants would have been screened without diagnosing a case of ROP of any stage, and no case of ROP requiring treatment would have been missed compared to the AAP recommendations. CONCLUSION: ROP requiring treatment is a rare occurrence in premature infants with a gestational age >30 weeks and body weight >1000 g at our institute. Nonetheless, this is not an attempt to alter national screening guidelines. A multicenter prospective study with an adequate sample size is needed to assess whether guidelines for ROP screening should be altered in this category of neonates. LIMITATIONS: Retrospective design. CONFLICT OF INTEREST: None.