SHOULD FEWER PREMATURE-INFANTS BE SCREENED FOR RETINOPATHY OF PREMATURITY IN THE MANAGED CARE ERA

Objective. To determine appropriate upper limits for gestational age a nd birth weight when screening infants for retinopathy of prematurity (ROP). Design. Retrospective survey. Setting. Tertiary neonatal intens ive care nursery. Patients. Seven hundred seven infants born July 1, 1 990 to June 30, 1996 and screened for ROP according to the 1988 to 199 6 American Academy of Pediatrics guidelines. Outcome Measures. Maximum stage of ROP with respect to birth weight and gestational age. Result s. No ROP more than Stage 1 was observed in infants with gestational a ges greater than or equal to 32 weeks or birth weights greater than or equal to 1500 g. All cases of threshold and Stage 4 ROP were confined to infants with gestational ages less than or equal to 30 weeks or bi rth weights <1200 g. Conclusions. The latest American Academy of Pedia trics screening guidelines for ROF 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 less than or equal to 1500 g, 34.2% fewer infants would require screening compared with the prev ious <1800 g recommendation, while missing no cases of ROP more than S tage 1. A gestational age cut-off of less than or equal to 28 weeks, h owever, is less desirable, and could potentially miss several infants with more advanced retinopathy (including Stage 4). If ROP screening c riteria 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 wi thout missing any cases of ROP more than Stage 1. Use of such a screen ing strategy (birth weight <1500 g or gestational age <32 weeks) is pr edicted to save in excess of 1.5 million dollars annually in the Unite d States, while missing no cases of ROP more than Stage 1.