Should Fewer Premature Infants Be Screened for Retinopathy of Prematurity in the Managed Care Era?

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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 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.