Factors in Premature Infants Associated with Low Risk of Developing Retinopathy of Prematurity

for the e-ROP Cooperative Group

Research output: Contribution to journalArticle

Abstract

Importance: Most premature infants will not develop retinopathy of prematurity (ROP) of clinical relevance, yet screening evaluations often continue beyond hospital discharge, even for those infants without ROP. Objectives: To identify the characteristics of infants at low risk for ROP, for whom further postdischarge screening may be of limited value. Design, Setting, and Participants: This study took place in North American neonatal intensive care units where clinicians had expertise in ROP. Infants with birth weight less than 1251 g who were born at or transferred into an Telemedicine Approaches to Evaluating Acute-Phase ROP (e-ROP) study center were enrolled. The study included post hoc analysis of prospectively collected in-hospital ROP examination results among infants enrolled in the e-ROP study. We characterized infants without ROP and performed logistic regression on the subset of infants who were 27 to 33 weeks' gestational age to determine characteristics associated with the absence of ROP during all in-hospital examinations. Main Outcomes and Measures: The main measure was the absence of ROP prior to hospital discharge; the main outcome was treatment for ROP. Results: A total of 1257 infants born at 22 to 35 weeks' gestation (median [interquartile range (IQR)], 26 [25-28] weeks) with birth weights less than 1251 g (median [IQR], 860 [690-1040] g) underwent 4113 ROP examinations between 31 and 47 weeks' postmenstrual age. Overall, 1153 examinations (38%) showed no ROP, and 456 infants (36%) did not have ROP prior to study center discharge or study end point. Among infants without ROP during examinations at 32 and 33 weeks' postmenstrual age, 16 (9.4%) and 14 (5.3%) subsequently underwent ROP treatment, respectively. At hospital discharge, there was no ROP in 59% of infants of 27 to 33 weeks' gestational age, compared with 15% of those who were less than 27 weeks' gestational age (difference, 44% [95% CI, 38.5%-48.1%]; P ≤.001). With more than 85% follow-up among infants without ROP by 37 weeks' postmenstrual age, none (95% CI, 0%-0.98%) were treated for ROP. In multivariate analysis of infants born at 27 to 33 weeks' gestation, larger birth weight (OR, 4.1 [95% CI, 1.6-10.3]) and higher gestational age (OR, 4.0 [95% CI, 1.5-10.8]) were significantly associated with absence of ROP. Conclusions and Relevance: These findings suggest that, for infants of 27 weeks' gestational age or greater and birth weights larger than 750 g, if no ROP has been detected by discharge at near-term postmenstrual age, then further ROP surveillance has limited value. Studies of all infants at risk are needed to develop more specific, objective criteria for termination of ROP surveillance and focus resources on infants at higher risk of ROP.

Original languageEnglish (US)
Pages (from-to)160-166
Number of pages7
JournalJAMA ophthalmology
Volume137
Issue number2
DOIs
StatePublished - Feb 1 2019

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Retinopathy of Prematurity
Premature Infants
Gestational Age
Birth Weight

ASJC Scopus subject areas

  • Ophthalmology

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Factors in Premature Infants Associated with Low Risk of Developing Retinopathy of Prematurity. / for the e-ROP Cooperative Group.

In: JAMA ophthalmology, Vol. 137, No. 2, 01.02.2019, p. 160-166.

Research output: Contribution to journalArticle

for the e-ROP Cooperative Group. / Factors in Premature Infants Associated with Low Risk of Developing Retinopathy of Prematurity. In: JAMA ophthalmology. 2019 ; Vol. 137, No. 2. pp. 160-166.
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abstract = "Importance: Most premature infants will not develop retinopathy of prematurity (ROP) of clinical relevance, yet screening evaluations often continue beyond hospital discharge, even for those infants without ROP. Objectives: To identify the characteristics of infants at low risk for ROP, for whom further postdischarge screening may be of limited value. Design, Setting, and Participants: This study took place in North American neonatal intensive care units where clinicians had expertise in ROP. Infants with birth weight less than 1251 g who were born at or transferred into an Telemedicine Approaches to Evaluating Acute-Phase ROP (e-ROP) study center were enrolled. The study included post hoc analysis of prospectively collected in-hospital ROP examination results among infants enrolled in the e-ROP study. We characterized infants without ROP and performed logistic regression on the subset of infants who were 27 to 33 weeks' gestational age to determine characteristics associated with the absence of ROP during all in-hospital examinations. Main Outcomes and Measures: The main measure was the absence of ROP prior to hospital discharge; the main outcome was treatment for ROP. Results: A total of 1257 infants born at 22 to 35 weeks' gestation (median [interquartile range (IQR)], 26 [25-28] weeks) with birth weights less than 1251 g (median [IQR], 860 [690-1040] g) underwent 4113 ROP examinations between 31 and 47 weeks' postmenstrual age. Overall, 1153 examinations (38{\%}) showed no ROP, and 456 infants (36{\%}) did not have ROP prior to study center discharge or study end point. Among infants without ROP during examinations at 32 and 33 weeks' postmenstrual age, 16 (9.4{\%}) and 14 (5.3{\%}) subsequently underwent ROP treatment, respectively. At hospital discharge, there was no ROP in 59{\%} of infants of 27 to 33 weeks' gestational age, compared with 15{\%} of those who were less than 27 weeks' gestational age (difference, 44{\%} [95{\%} CI, 38.5{\%}-48.1{\%}]; P ≤.001). With more than 85{\%} follow-up among infants without ROP by 37 weeks' postmenstrual age, none (95{\%} CI, 0{\%}-0.98{\%}) were treated for ROP. In multivariate analysis of infants born at 27 to 33 weeks' gestation, larger birth weight (OR, 4.1 [95{\%} CI, 1.6-10.3]) and higher gestational age (OR, 4.0 [95{\%} CI, 1.5-10.8]) were significantly associated with absence of ROP. Conclusions and Relevance: These findings suggest that, for infants of 27 weeks' gestational age or greater and birth weights larger than 750 g, if no ROP has been detected by discharge at near-term postmenstrual age, then further ROP surveillance has limited value. Studies of all infants at risk are needed to develop more specific, objective criteria for termination of ROP surveillance and focus resources on infants at higher risk of ROP.",
author = "{for the e-ROP Cooperative Group} and Wade, {Kelly C.} and Ying, {Gui Shuang} and Agnieshka Baumritter and Alice Gong and Kemper, {Alex R.} and Quinn, {Graham E.} and Duros, {Trang B.} and Lisa Erbring and Repka, {Michael X} and Shepard, {Jennifer A.} and David Emmert and Herring, {C. Mark} and Deborah VanderVeen and Suzanne Johnston and Carolyn Wu and Jason Mantagos and Danille Ledoux and Tamar Winter and Frank Weng and Theresa Mansfield and Bremer, {Don L.} and McGregor, {Mary Lou} and Jordan, {Catherine Olson} and Rogers, {David L.} and Fellows, {Rae R.} and Suzanne Brandt and Brenda Mann and David Wallace and Sharon Freedman and Jones, {Sarah K.} and Du Tran-Viet and Young, {Rhonda Michelle} and Barr, {Charles C.} and Rahul Bhola and Craig Douglas and Peggy Fishman and Michelle Bottorff and Brandi Hubbuch and Rachel Keith and Bothun, {Erick D.} and Inge DeBecker and Jill Anderson and Holleschau, {Ann Marie} and Miller, {Nichole E.} and Nyquist, {Darla N.} and Siatkowski, {R. Michael} and Lucas Trigler and Marilyn Escobedo and Karen Corff and Michelle Huynh",
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T1 - Factors in Premature Infants Associated with Low Risk of Developing Retinopathy of Prematurity

AU - for the e-ROP Cooperative Group

AU - Wade, Kelly C.

AU - Ying, Gui Shuang

AU - Baumritter, Agnieshka

AU - Gong, Alice

AU - Kemper, Alex R.

AU - Quinn, Graham E.

AU - Duros, Trang B.

AU - Erbring, Lisa

AU - Repka, Michael X

AU - Shepard, Jennifer A.

AU - Emmert, David

AU - Herring, C. Mark

AU - VanderVeen, Deborah

AU - Johnston, Suzanne

AU - Wu, Carolyn

AU - Mantagos, Jason

AU - Ledoux, Danille

AU - Winter, Tamar

AU - Weng, Frank

AU - Mansfield, Theresa

AU - Bremer, Don L.

AU - McGregor, Mary Lou

AU - Jordan, Catherine Olson

AU - Rogers, David L.

AU - Fellows, Rae R.

AU - Brandt, Suzanne

AU - Mann, Brenda

AU - Wallace, David

AU - Freedman, Sharon

AU - Jones, Sarah K.

AU - Tran-Viet, Du

AU - Young, Rhonda Michelle

AU - Barr, Charles C.

AU - Bhola, Rahul

AU - Douglas, Craig

AU - Fishman, Peggy

AU - Bottorff, Michelle

AU - Hubbuch, Brandi

AU - Keith, Rachel

AU - Bothun, Erick D.

AU - DeBecker, Inge

AU - Anderson, Jill

AU - Holleschau, Ann Marie

AU - Miller, Nichole E.

AU - Nyquist, Darla N.

AU - Siatkowski, R. Michael

AU - Trigler, Lucas

AU - Escobedo, Marilyn

AU - Corff, Karen

AU - Huynh, Michelle

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Importance: Most premature infants will not develop retinopathy of prematurity (ROP) of clinical relevance, yet screening evaluations often continue beyond hospital discharge, even for those infants without ROP. Objectives: To identify the characteristics of infants at low risk for ROP, for whom further postdischarge screening may be of limited value. Design, Setting, and Participants: This study took place in North American neonatal intensive care units where clinicians had expertise in ROP. Infants with birth weight less than 1251 g who were born at or transferred into an Telemedicine Approaches to Evaluating Acute-Phase ROP (e-ROP) study center were enrolled. The study included post hoc analysis of prospectively collected in-hospital ROP examination results among infants enrolled in the e-ROP study. We characterized infants without ROP and performed logistic regression on the subset of infants who were 27 to 33 weeks' gestational age to determine characteristics associated with the absence of ROP during all in-hospital examinations. Main Outcomes and Measures: The main measure was the absence of ROP prior to hospital discharge; the main outcome was treatment for ROP. Results: A total of 1257 infants born at 22 to 35 weeks' gestation (median [interquartile range (IQR)], 26 [25-28] weeks) with birth weights less than 1251 g (median [IQR], 860 [690-1040] g) underwent 4113 ROP examinations between 31 and 47 weeks' postmenstrual age. Overall, 1153 examinations (38%) showed no ROP, and 456 infants (36%) did not have ROP prior to study center discharge or study end point. Among infants without ROP during examinations at 32 and 33 weeks' postmenstrual age, 16 (9.4%) and 14 (5.3%) subsequently underwent ROP treatment, respectively. At hospital discharge, there was no ROP in 59% of infants of 27 to 33 weeks' gestational age, compared with 15% of those who were less than 27 weeks' gestational age (difference, 44% [95% CI, 38.5%-48.1%]; P ≤.001). With more than 85% follow-up among infants without ROP by 37 weeks' postmenstrual age, none (95% CI, 0%-0.98%) were treated for ROP. In multivariate analysis of infants born at 27 to 33 weeks' gestation, larger birth weight (OR, 4.1 [95% CI, 1.6-10.3]) and higher gestational age (OR, 4.0 [95% CI, 1.5-10.8]) were significantly associated with absence of ROP. Conclusions and Relevance: These findings suggest that, for infants of 27 weeks' gestational age or greater and birth weights larger than 750 g, if no ROP has been detected by discharge at near-term postmenstrual age, then further ROP surveillance has limited value. Studies of all infants at risk are needed to develop more specific, objective criteria for termination of ROP surveillance and focus resources on infants at higher risk of ROP.

AB - Importance: Most premature infants will not develop retinopathy of prematurity (ROP) of clinical relevance, yet screening evaluations often continue beyond hospital discharge, even for those infants without ROP. Objectives: To identify the characteristics of infants at low risk for ROP, for whom further postdischarge screening may be of limited value. Design, Setting, and Participants: This study took place in North American neonatal intensive care units where clinicians had expertise in ROP. Infants with birth weight less than 1251 g who were born at or transferred into an Telemedicine Approaches to Evaluating Acute-Phase ROP (e-ROP) study center were enrolled. The study included post hoc analysis of prospectively collected in-hospital ROP examination results among infants enrolled in the e-ROP study. We characterized infants without ROP and performed logistic regression on the subset of infants who were 27 to 33 weeks' gestational age to determine characteristics associated with the absence of ROP during all in-hospital examinations. Main Outcomes and Measures: The main measure was the absence of ROP prior to hospital discharge; the main outcome was treatment for ROP. Results: A total of 1257 infants born at 22 to 35 weeks' gestation (median [interquartile range (IQR)], 26 [25-28] weeks) with birth weights less than 1251 g (median [IQR], 860 [690-1040] g) underwent 4113 ROP examinations between 31 and 47 weeks' postmenstrual age. Overall, 1153 examinations (38%) showed no ROP, and 456 infants (36%) did not have ROP prior to study center discharge or study end point. Among infants without ROP during examinations at 32 and 33 weeks' postmenstrual age, 16 (9.4%) and 14 (5.3%) subsequently underwent ROP treatment, respectively. At hospital discharge, there was no ROP in 59% of infants of 27 to 33 weeks' gestational age, compared with 15% of those who were less than 27 weeks' gestational age (difference, 44% [95% CI, 38.5%-48.1%]; P ≤.001). With more than 85% follow-up among infants without ROP by 37 weeks' postmenstrual age, none (95% CI, 0%-0.98%) were treated for ROP. In multivariate analysis of infants born at 27 to 33 weeks' gestation, larger birth weight (OR, 4.1 [95% CI, 1.6-10.3]) and higher gestational age (OR, 4.0 [95% CI, 1.5-10.8]) were significantly associated with absence of ROP. Conclusions and Relevance: These findings suggest that, for infants of 27 weeks' gestational age or greater and birth weights larger than 750 g, if no ROP has been detected by discharge at near-term postmenstrual age, then further ROP surveillance has limited value. Studies of all infants at risk are needed to develop more specific, objective criteria for termination of ROP surveillance and focus resources on infants at higher risk of ROP.

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