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Do extremely preterm infants need retinopathy of prematurity screening earlier than 31 weeks postmenstrual age?

Journal of Perinatology volume 41, pages 305–309 (2021)Cite this article

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Abstract

Objective

To evaluate the utility of screening all extremely preterm infants for retinopathy of prematurity (ROP) at 4 weeks chronologic age, which is earlier than recommended by the 2018 AAP guidelines.

Study design

Retrospective analysis of infants <27 weeks gestation from two tertiary NICUs between 2006 and 2018 who survived until first eye examination.

Results

550 infants (gestational age 25.1 ± 1.2 weeks and birth weight 758 ± 323 g) had 1310 examinations performed by 32 weeks postmenstrual age (PMA), and 676 (51.6%) of these were prior to 31 weeks PMA. No examinations in infants prior to 31 weeks PMA met the criteria for laser therapy. Of 87/550 infants (15.8%) who required laser therapy, none did so prior to 32 weeks PMA.

Conclusions

No infants born <27 weeks gestation were found to have severe ROP prior to 31 weeks PMA, supporting the most recent AAP recommendation of initiating ROP screening at 31 weeks PMA for extremely preterm infants.

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References

  1. Jefferies AL. Canadian Paediatric Society, Fetus and Newborn Committee. Retinopathy of prematurity: recommendations for screening. Paediatr Child Health. 2010;15:667–74.

    Article  Google Scholar 

  2. American Academy of Pediatrics. Section on Ophthalmology. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2001;108:809–11.

    Article  Google Scholar 

  3. Fierson WM, Ophthalmology American Academic of Pediatrics Section on Ophthalmology, American Academy Of Ophthalmology, American Association For Pediatric Ophthalmology, Strabismus, American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2018;142:1–9.

  4. Fierson WM. American Academic of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology, Strabismus, American Association of Certified Orthoptists. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2013;131:189–95.

    Article  Google Scholar 

  5. Mitchell AJ, Green A, Jeffs DA, Roberson PK. Physiologic effects of retinopathy of prematurity screening examinations. Adv Neonatal Care. 2011;11:291–7.

    Article  Google Scholar 

  6. Section on Ophthalmology American Academy of Pediatrics, American Academy of Ophthalmology, American Association for Pediatric Ophthalmology, Strabismus. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2006;117:572–6.

    Article  Google Scholar 

  7. Palmer EA. Results of U.S. randomized clinical trial of cryotherapy for ROP (CRYO-ROP). Doc Ophthalmol. 1990;74:245–51.

    Article  CAS  Google Scholar 

  8. Palmer EA, Hardy RJ, Dobson V, Phelps DL, Quinn GE, Summers CG, et al. 15-year outcomes following threshold retinopathy of prematurity: final results from the multicenter trial of cryotherapy for retinopathy of prematurity. Arch Ophthalmol. 2005;123:311–8.

    Article  Google Scholar 

  9. Good WV, Hardy RJ, Dobson V, Palmer EA, Phelps DL, Quintos M, et al. The incidence and course of retinopathy of prematurity: findings from the early treatment for retinopathy of prematurity study. Pediatrics. 2005;116:15–23.

    Article  Google Scholar 

  10. International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123:991–9.

    Article  Google Scholar 

  11. Hered RW, Gyland EA. The retinopathy of prematurity screening examination: ensuring a safe and efficient examination while minimizing infant discomfort. Neonatal Netw. 2010;29:143–51.

    Article  Google Scholar 

  12. Anand KJ. International evidence-based group for neonatal pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001;155:173–80.

    Article  CAS  Google Scholar 

  13. Belda S, Pallas CR, De la Cruz J, Tejada P. Screening for retinopathy of prematurity: is it painful? Biol Neonate. 2004;86:195–200.

    Article  Google Scholar 

  14. Mitchell A, Hall RW, Erickson SW, Yates C, Hendrickson H. Systemic absorption of cyclopentolate and adverse events after retinopathy of prematurity exams. Curr Eye Res. 2016;41:1601–7.

    Article  CAS  Google Scholar 

  15. Degirmencioglu H, Oncel MY, Calisici E, Say B, Uras N, Dilmen U. Transient ileus associated with the use of mydriatics after screening for retinopathy of prematurity in a very low birth weight infant. J Pediatr Ophthalmol Strabismus. 2014;51:e44–47.

    PubMed  Google Scholar 

  16. Agrawal Y, Patri S, Kalavakunta JK, Gupta V. Retinopathy of prematurity screening leading to cardiopulmonary arrest: fatal complication of a benign procedure. BMJ Case Rep. 2016;2016:1–2.

  17. Lee JM, Kodsi SR, Gaffar MA, Rubin SE. Cardiopulmonary arrest following administration of Cyclomydril eyedrops for outpatient retinopathy of prematurity screening. J AAPOS. 2014;18:183–4.

    Article  Google Scholar 

  18. Rush R, Rush S, Nicolau J, Chapman K, Naqvi M. Systemic manifestations in response to mydriasis and physical examination during screening for retinopathy of prematurity. Retina. 2004;24:242–5.

    Article  Google Scholar 

  19. Sammons JS, Graf EH, Townsend S, Hoegg CL, Smathers SA, Coffin SE, et al. Outbreak of adenovirus in a neonatal intensive care unit: critical importance of equipment cleaning during inpatient ophthalmologic examinations. Ophthalmology. 2019;126:137–43.

    Article  Google Scholar 

  20. Hutchinson AK, Saunders RA, O’Neil JW, Lovering A, Wilson ME. Timing of initial screening examinations for retinopathy of prematurity. Arch Ophthalmol. 1998;116:608–12.

    Article  CAS  Google Scholar 

  21. Austeng D, Kallen KB, Hellstrom A, Jakobsson PG, Johansson K, Tornqvist K, et al. Screening for retinopathy of prematurity in infants born before 27 weeks’ gestation in Sweden. Arch Ophthalmol. 2011;129:167–72.

    Article  Google Scholar 

  22. Lundgren P, Lundberg L, Hellgren G, Holmstrom G, Hard AL, Smith LE, et al. Aggressive posterior retinopathy of prematurity is associated with multiple infectious episodes and thrombocytopenia. Neonatology. 2017;111:79–85.

    Article  Google Scholar 

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Author information

Author notes

  1. Zubair H. Aghai

    Present address: Division of Neonatology, Thomas Jefferson University/Nemours, 833 Chestnut Street, Suite 1237, Philadelphia, PA, USA

Authors and Affiliations

  1. Pediatrics/Neonatology, Thomas Jefferson University/Nemours, Philadelphia, PA, USA

    Amy J. Sloane, Elizabeth A. O’Donnell, Jay S. Greenspan & Zubair H. Aghai

  2. Pediatrics/Neonatology, Christiana Care Health System, Newark, DE, USA

    Amy B. Mackley & David A. Paul

  3. Pediatrics/Ophthalmology, Thomas Jefferson University/Nemours, Philadelphia, PA, USA

    Julia E. Reid

Authors
  1. Amy J. Sloane
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  2. Elizabeth A. O’Donnell
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  3. Amy B. Mackley
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  4. Julia E. Reid
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  5. Jay S. Greenspan
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  6. David A. Paul
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  7. Zubair H. Aghai
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Contributions

AJS and EAO conceptualized the study, searched literature, collected and analyzed data, drafted initial manuscript, and approved the final manuscript as submitted. ABM collected data, reviewed and revised the manuscript and approved the final manuscript as submitted. ZHA, DAP, JER, and JSG conceptualized and designed the study, analyzed data, critically reviewed and revised the manuscript and approved the final manuscript as submitted. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Zubair H. Aghai.

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The authors declare that they have no conflict of interest.

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Sloane, A.J., O’Donnell, E.A., Mackley, A.B. et al. Do extremely preterm infants need retinopathy of prematurity screening earlier than 31 weeks postmenstrual age?. J Perinatol 41, 305–309 (2021). https://doi.org/10.1038/s41372-020-0681-6

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  • DOI: https://doi.org/10.1038/s41372-020-0681-6

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