Refining evidence-based retinopathy of prematurity screening guidelines: The SCREENROP study

Kourosh Sabri; Sandesh Shivananda; Forough Farrokhyar; Alessandro Selvitella; Bethany Easterbrook B Kin; Wendy Seidlitz; Shoo K Lee; Canadian Neonatal Network and the Canadian Association of Pediatric Ophthalmology and Strabismus

doi:10.1093/pch/pxz085

Refining evidence-based retinopathy of prematurity screening guidelines: The SCREENROP study

Paediatr Child Health. 2019 Aug 12;25(7):455-466. doi: 10.1093/pch/pxz085. eCollection 2020 Nov.

Collaborators

Canadian Neonatal Network and the Canadian Association of Pediatric Ophthalmology and Strabismus:
Kaitlyn Whelan, Prakesh S Shah, Jane Gardiner, Xiang Y Ye, Andrew Budning, Ian Clark, Vasudha Erraguntla, Anick Fournier, Patrick Hamel, Elise Heon, Gloria Isaza-Zapata, Christopher Lyons, Ian MacDonald, Inas Makar, Peter Kertes, Mark Greve, Matthew Tennant, Kamiar Mireskandari, Fariba Nazemi, Michael O'Connor, Luis Ospina, Victor Pegado, Johane Robitaille, Sapna Sharan, Dayle Sigesmund, Carlos Solarte, Yi Ning Strube, Rosanne Superstein, Nasrin Tehrani, Conor Mulholland, Naeem Nabi, Anne Synnes, Joseph Ting, Nicole Rouvinez-Bouali, Bruno Piedboeuf, Christine Drolet, Valerie Bertelle, Edith Masse, Hala Makary, Wendy Yee, Adele Harrison, Molly Seshia, Keith Barrington, Jehier Afifi, Akhil Deshpandey, Ermelinda Pelausa, Kimberly Dow, Patricia Riley, Martine Claveau, Khalid Aziz, Zenon Cieslak, Zarin Kalapesi, Koravangattu Sankaran, Daniel Faucher, Ruben Alvaro, Roderick Canning, Orlando da Silva, Cecil Ojah, Luis Monterrosa, Michael Dunn, Todd Sorokan, Andrzej Kajetanowicz, Chuks Nwaesei, Carlos Fajardo, Sahira Husain, Sunny Xia, Virginia Viscardi, Sonny Yeh, Laura Schneider

Affiliations

¹ Division of Ophthalmology, Department of Surgery, McMaster University, Hamilton, Ontario.
² McMaster Paediatric Eye Research Group, Department of Surgery, McMaster University, Hamilton, Ontario.
³ McMaster Paediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario.
⁴ Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario.
⁵ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario.
⁶ Office of Surgical Research Services, Department of Surgery, McMaster University, Hamilton, Ontario.
⁷ Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario.
⁸ McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario.
⁹ Canadian Neonatal Network, Toronto, Ontario.

Abstract

Purpose: Retinopathy of prematurity (ROP) is a potentially blinding condition affecting premature infants for which less than 10% of babies undergoing screening require treatment. This study assessed and validated predictors of developing clinically significant ROP (type 2 or worse) and ROP requiring treatment.

Design: Nationwide retrospective cohort study.

Methods: This study included infants born between January 2014 and June 2016, admitted to level 3 neonatal intensive care units across Canada who underwent ROP screening. Data were derived from the Canadian Neonatal Network database. Predefined ≥ 1% risk for clinically significant retinopathy or prematurity and ROP requiring treatment was set as threshold for screening. Thirty-two potential predictors were analyzed, to identify and validate the most important ones for predicting clinically significant ROP. The predictors were determined on a derivation cohort and tested on a validation cohort. Multivariable logistic regression modeling was used for analysis.

Results: Using a sample of 4,888 babies and analyzing 32 potential predictors, capturing babies with ≥1% risk of developing clinically significant ROP equated to screening babies with birth weight (BW) <1,300 g or gestational age (GA) <30 weeks while capturing babies with ≥1% risk of requiring ROP treatment equated to screening babies with BW <1,200 g or GA <29 weeks.

Conclusions: The Canadian ROP screening criteria can be modified to screen babies with BW <1,200 g or GA <30 weeks. Using these criteria, babies requiring treatment would be identified while reducing the number of babies screened unnecessarily.

Keywords: Birth weight; Extremely premature; Eye; Gestational age; Infant; Premature; Retina.