Evaluating the Utility of Initial Examinations in Retinopathy of Prematurity: Proposal of FIRST-ROP Algorithm for a Medium-Risk Cohort.

Purpose: To assess the utility of the first or second examinations for retinopathy of prematurity (ROP) in a medium-risk cohort of infants and to propose an optimization to the current ROP screening guidelines.

Design: Retrospective consecutive study.

Participants: Infants screened for ROP between January 2017 and August 2023 at 3 different tertiary-level care neonatal intensive care units.

Methods: Analysis of patients who did not meet criteria for microprematurity or nanoprematurity (those born at ≥ 27 weeks and weighing ≥ 800 g).

Main outcome measures: The primary outcomes included the rates of ROP and treatment-warranted ROP (TW-ROP), the presence of TW-ROP at the first or second inpatient examinations, the number of inpatient examinations performed before the first ROP diagnosis, and the overall number of inpatient examinations performed.

Results: A total of 2004 neonates were screened for ROP, among whom 1125 (56.1%) met the inclusion criteria. Of those, 237 neonates (21.1%) had ROP. Eleven infants (1.0%) required treatment for active disease. The median postmenstrual age (PMA) at first ROP diagnosis was 35.3 weeks (interquartile range [IQR], 33.7-37 weeks; range, 30.3-46.7 weeks). The median PMA at stage 3 diagnosis was 39.3 weeks (IQR, 38.3-41.2 weeks; range, 35.1-44.4 weeks). The median PMA at first treatment was 39.6 weeks (IQR, 35.8-43.3 weeks; range, 35.3-49.6 weeks). The median number of inpatient examinations was 2.0 (IQR, 1-4 examinations) for traditional screening, 1.0 examination (IQR, 1-3 examinations) after eliminating the first ROP inpatient examination, and 1.0 examination (IQR, 1-2 examinations) after eliminating the first and second ROP examinations (P < 0.001). No patients met type 1 ROP treatment criteria at either the first or second inpatient examination (100% sensitivity for TW-ROP). In this cohort, starting examinations at 34 weeks' PMA could save 30.6% of inpatient examinations.

Conclusions: In infants not meeting criteria for microprematurity or nanoprematurity, no type 1 ROP was diagnosed at either of the first 2 inpatient examinations. We propose an amendment algorithm (FIRST-ROP) in which ROP examinations start at 34 weeks' PMA for neonates born at ≥27 weeks gestational age and ≥800 grams.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.