Evaluating the Utility of Initial Exams 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.

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

Methods: The analysis focused on patients who did not meet criteria for micro or nanoprematurity (those born at ≥27 weeks and weighing ≥800 grams).

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 2,004 neonates were screened for ROP, of which 1,125 (56.1%) met the inclusion criteria. Of those patients, 237 (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 (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 exams) for traditional screening, 1.0 (IQR, 1-3) after eliminating the first ROP inpatient examination, and 1.0 (IQR, 1-2) after eliminating the first and second ROP examinations (p<0.001). No patients were diagnosed with stage ≥3 nor met type 1 ROP treatment criteria at the first or second inpatient examination (100% sensitivity for TW-ROP). In this cohort, starting exams at 34 weeks PMA would be estimated to save 30.6% of the inpatient examinations.

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