Timing of Retinopathy of Prematurity Diagnosis and Treatment in Micro-Premature and Nano-Premature Infants During Inpatient Screening.

Abstract

Objective: We aimed to determine the timing of retinopathy of prematurity (ROP) diagnosis and treatment in a cohort of infants meeting criteria for micro and/or nano-prematurity with the goal of informing screening protocols in this high-risk group.

Design: Retrospective consecutive study.

Participants: We included all screened infants who met the criteria for micro-prematurity (24-26 weeks GA and/or BW 600-799 grams) or nano-prematurity (<24 weeks GA and/or BW <600 grams).

Methods: Data collected from 2013 to 2023 included GA at birth, BW, postmenstrual age (PMA) at ROP diagnosis, PMA at type 1 ROP diagnosis, and number of inpatient examinations.

Main outcomes measures: Rates of ROP and treatment-warranted ROP, timing to first ROP diagnosis and treatment-warranted ROP, and the number of examinations.

Results: 3239 infants were screened during this time period for ROP, and 650 infants met inclusion criteria. The median GA at birth and BW were 25.3 weeks and 682.5 grams, respectively. 456 infants (70.2%) were micro-premature and 194 (29.8%) were nano-premature. ROP was detected in 524 patients (80.6%). The median PMA at first ROP diagnosis was 33.7 weeks. The median interval from birth to first ROP diagnosis was 8.4 weeks. The median exam number at first ROP diagnosis was the second exam. The median number of inpatient examinations was 9. Of ROP patients, 180 (34.4%) had ROP diagnosis at their first examination. A total of 126 (19.4% of all infants and 24.0% of those with ROP) infants met type 1 treatment criteria. The median PMA at type 1 ROP diagnosis was 37 weeks . The median interval from birth to type 1 ROP was 12 weeks. The median exam number at type 1 diagnosis was the 5th exam.

Conclusions: In this modern cohort of high-risk extremely premature infants, 9 patients (1.4%) were diagnosed with type 1 ROP on the first or second inpatient exams. These infants had generally good outcomes after treatment, with only two eyes of one patient progressing to stage 4 disease. Our findings support maintaining current screening guidelines for high-risk extremely premature infants, while suggesting opportunities for optimizing screening approaches through risk stratification.