Proposed New Retinopathy of Prematurity Screening Criteria: Evidence for Including Older and Heavier Filipino Premature Babies

Abstract

Objective: (1) To determine if preterm babies with ROP are missed with the existing Philippine Pediatric Society-Philippine Academy of Ophthalmology 2005 screening criteria of ≤32 weeks gestational age (GA) and ≤1,500 grams birth weight (BW), (2) to determine the incidence (missed-out rate) of these babies with ROP (>32 weeks GA, >1,500 grams BW), (3) to describe their profile, and (4) to determine the appropriate upper limit for GA and BW that can provide safe and efficient screening for severe ROP.

Methods: This is a multicenter, retrospective cohort, observational study using data on ROP screening from the medical records of preterm babies from 4 institutions. All babies born ≤36 weeks GA, regardless of BW, who previously underwent ROP screening in 2011-2013, were included. Outcome measures were: (1) missed-out rate, (2) profile of missed babies with ROP (GA, BW, and risk factors), and (3) the proposed new criteria.

Results: Of the 762 babies screened, 105 (13.8%) had ROP. Of these, 13 (12%) had severe ROP, 28 (27%) was born at 33-36 weeks GA, and 32 (30%) with >1,500 grams BW. The oldest and heaviest of these missed babies with type 1 ROP was almost consistently reported at <35 weeks GA and <2,000 grams BW. Associated significant risk factors seen among missed babies were sepsis, respiratory distress syndrome (RDS), oxygen supplementation, and blood transfusion. There were 45 babies (43%) with ROP but with no risk factors. Among these were babies with GA >32 weeks and BW >1500 grams with ROP. The incidences of ROP, with and without risk factors, inthe 4 institutions were not statistically significant. Seventeen (16.2%) preterm babies were missed with the existing criteria. Two of these had no risk factors but had type 1 and type 2 ROP. When <35 weeks GA and <2,000 grams BW as the new criteria were applied, the missed-out rate was reduced to 2% and was further reduced to zero with the inclusion of risk factors.

Conclusion: The existing ROP screening criteria of ≤32 weeks GA and ≤1500 grams BW missed babies with severe ROP and need to be modified. We recommend screening Filipino babies: (1) <35 weeks GA and/or <2,000 grams BW, and (2) ≥35 weeks GA or ≥2,000 grams BW with risk factors.