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Pediatrics. 1998 Jul;102(1 Pt 1):31-4.

Should fewer premature infants be screened for retinopathy of prematurity in the managed care era?

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  • 1Department of Pediatrics, University of Tennessee Graduate School of Medicine, Knoxville, TN 37920, USA.

Abstract

OBJECTIVE:

To determine appropriate upper limits for gestational age and birth weight when screening infants for retinopathy of prematurity (ROP).

DESIGN:

Retrospective survey.

SETTING:

Tertiary neonatal intensive care nursery.

PATIENTS:

Seven hundred seven infants born July 1, 1990 to June 30, 1996 and screened for ROP according to the 1988 to 1996 American Academy of Pediatrics guidelines.

OUTCOME MEASURES:

Maximum stage of ROP with respect to birth weight and gestational age.

RESULTS:

No ROP more than Stage 1 was observed in infants with gestational ages >/=32 weeks or birth weights >/=1500 g. All cases of threshold and Stage 4 ROP were confined to infants with gestational ages </=30 weeks or birth weights <1200 g.

CONCLUSIONS:

The latest American Academy of Pediatrics screening guidelines for ROP are discretionary for infants with birth weights >1500 g or gestational ages >28 weeks. If ROP screening is limited to infants with birth weights of </=1500 g, 34.2% fewer infants would require screening compared with the previous <1800 g recommendation, while missing no cases of ROP more than Stage 1. A gestational age cut-off of </=28 weeks, however, is less desirable, and could potentially miss several infants with more advanced retinopathy (including Stage 4). If ROP screening criteria were instead modified to include infants of gestational ages <32 weeks, the number of patients requiring screening could be reduced 29.1% compared with the previous recommendation of <35 weeks, again without missing any cases of ROP more than Stage 1. Use of such a screening strategy (birth weight <1500 g or gestational age <32 weeks) is predicted to save in excess of 1.5 million dollars annually in the United States, while missing no cases of ROP more than Stage 1.

PMID:
9651410
[PubMed - indexed for MEDLINE]
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