Predictors for the development of referral-warranted retinopathy of prematurity in the telemedicine approaches to evaluating acute-phase retinopathy of prematurity (e-ROP) study

e-ROP Cooperative Group

Research output: Contribution to journalArticle

Abstract

IMPORTANCE: Detection of treatment-requiring retinopathy of prematurity (ROP) involves serial eye examinations. An ROP prediction model using predictive factors could identify high-risk infants and reduce required eye examinations. OBJECTIVE: To determine predictive factors for the development of referral-warranted (RW) ROP. DESIGN, SETTING, AND PARTICIPANTS: This multicenter observational cohort study included secondary analysis of data from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study. Infants included in the study had a birth weight (BW) of less than 1251 g. EXPOSURES: Serial ROP examinations of premature infants who had 2 or more ROP examinations. MAIN OUTCOMES AND MEASURES: Incidence of RW-ROP (defined as the presence of plus disease, zone I ROP, or ROP stage 3 or greater in either eye) and associations with predictive factors. RESULTS: Among 979 infants without RW-ROP at first study-related eye examination (median postmenstrual age, 33 weeks; range, 29-40 weeks) who underwent at least 2 eye examinations, 149 (15.2%) developed RW-ROP. In a multivariate model, significant predictors for RW-ROP were male sex (odds ratio [OR], 1.80; 95%CI, 1.13-2.86 vs female), nonblack race (OR, 2.76; 95%CI, 1.50-5.08 for white vs black race and OR, 4.81; 95%CI, 2.19-10.6 for other vs black race), low BW(OR, 5.16; 95%CI, 1.12-7.20 for ≤500 g vs >1100 g), younger gestational age (OR, 9.79; 95%CI, 3.49-27.5 for ≤24 weeks vs ≥28 weeks), number of quadrants with preplus disease (OR, 7.12; 95%CI, 2.53-20.1 for 1-2 quadrants and OR, 18.4; 95%CI, 4.28-79.4 for 3-4 quadrants vs no preplus disease), stage 2 ROP (OR, 4.13; 95%CI, 2.13-8.00 vs no ROP), the presence of retinal hemorrhage (OR, 4.36; 95%CI, 1.57-12.1 vs absence), the need for respiratory support (OR, 4.99; 95%CI, 1.89-13.2 for the need for controlled mechanical ventilator; OR, 11.0; 95%CI, 2.26-53.8 for the need for high-frequency oscillatory ventilation vs no respiratory support), and slow weight gain (OR, 2.44; 95%CI, 1.22-4.89 for weight gain ≤12 g/d vs >18 g/d). These characteristics predicted the development of RW-ROP significantly better than BW and gestational age (area under receiver operating characteristic curve, 0.88 vs 0.78; P <.001). CONCLUSIONS AND RELEVANCE: When controlling for very low BW and prematurity, the presence of preplus disease, stage 2 ROP, retinal hemorrhage, and the need for ventilation at time of first study-related eye examination were strong independent predictors for RW-ROP. These predictors may help identify infants in need of timely eye examinations.

Original languageEnglish (US)
Pages (from-to)304-311
Number of pages8
JournalJAMA Ophthalmology
Volume133
Issue number3
DOIs
StatePublished - Mar 1 2015

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Retinopathy of Prematurity
Telemedicine
Referral and Consultation
Odds Ratio
Retinal Hemorrhage
Birth Weight
Gestational Age
Weight Gain
High-Frequency Ventilation
Very Low Birth Weight Infant
Sex Ratio
Low Birth Weight Infant

ASJC Scopus subject areas

  • Ophthalmology

Cite this

@article{93e762181e6940689f6cd3b558dcd78b,
title = "Predictors for the development of referral-warranted retinopathy of prematurity in the telemedicine approaches to evaluating acute-phase retinopathy of prematurity (e-ROP) study",
abstract = "IMPORTANCE: Detection of treatment-requiring retinopathy of prematurity (ROP) involves serial eye examinations. An ROP prediction model using predictive factors could identify high-risk infants and reduce required eye examinations. OBJECTIVE: To determine predictive factors for the development of referral-warranted (RW) ROP. DESIGN, SETTING, AND PARTICIPANTS: This multicenter observational cohort study included secondary analysis of data from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study. Infants included in the study had a birth weight (BW) of less than 1251 g. EXPOSURES: Serial ROP examinations of premature infants who had 2 or more ROP examinations. MAIN OUTCOMES AND MEASURES: Incidence of RW-ROP (defined as the presence of plus disease, zone I ROP, or ROP stage 3 or greater in either eye) and associations with predictive factors. RESULTS: Among 979 infants without RW-ROP at first study-related eye examination (median postmenstrual age, 33 weeks; range, 29-40 weeks) who underwent at least 2 eye examinations, 149 (15.2{\%}) developed RW-ROP. In a multivariate model, significant predictors for RW-ROP were male sex (odds ratio [OR], 1.80; 95{\%}CI, 1.13-2.86 vs female), nonblack race (OR, 2.76; 95{\%}CI, 1.50-5.08 for white vs black race and OR, 4.81; 95{\%}CI, 2.19-10.6 for other vs black race), low BW(OR, 5.16; 95{\%}CI, 1.12-7.20 for ≤500 g vs >1100 g), younger gestational age (OR, 9.79; 95{\%}CI, 3.49-27.5 for ≤24 weeks vs ≥28 weeks), number of quadrants with preplus disease (OR, 7.12; 95{\%}CI, 2.53-20.1 for 1-2 quadrants and OR, 18.4; 95{\%}CI, 4.28-79.4 for 3-4 quadrants vs no preplus disease), stage 2 ROP (OR, 4.13; 95{\%}CI, 2.13-8.00 vs no ROP), the presence of retinal hemorrhage (OR, 4.36; 95{\%}CI, 1.57-12.1 vs absence), the need for respiratory support (OR, 4.99; 95{\%}CI, 1.89-13.2 for the need for controlled mechanical ventilator; OR, 11.0; 95{\%}CI, 2.26-53.8 for the need for high-frequency oscillatory ventilation vs no respiratory support), and slow weight gain (OR, 2.44; 95{\%}CI, 1.22-4.89 for weight gain ≤12 g/d vs >18 g/d). These characteristics predicted the development of RW-ROP significantly better than BW and gestational age (area under receiver operating characteristic curve, 0.88 vs 0.78; P <.001). CONCLUSIONS AND RELEVANCE: When controlling for very low BW and prematurity, the presence of preplus disease, stage 2 ROP, retinal hemorrhage, and the need for ventilation at time of first study-related eye examination were strong independent predictors for RW-ROP. These predictors may help identify infants in need of timely eye examinations.",
author = "{e-ROP Cooperative Group} and Ying, {Gui Shuang} and Quinn, {Graham E.} and Wade, {Kelly C.} and Repka, {Michael X} and Agnieshka Baumritter and Ebenezer Daniel",
year = "2015",
month = "3",
day = "1",
doi = "10.1001/jamaophthalmol.2014.5185",
language = "English (US)",
volume = "133",
pages = "304--311",
journal = "JAMA Ophthalmology",
issn = "2168-6165",
publisher = "American Medical Association",
number = "3",

}

TY - JOUR

T1 - Predictors for the development of referral-warranted retinopathy of prematurity in the telemedicine approaches to evaluating acute-phase retinopathy of prematurity (e-ROP) study

AU - e-ROP Cooperative Group

AU - Ying, Gui Shuang

AU - Quinn, Graham E.

AU - Wade, Kelly C.

AU - Repka, Michael X

AU - Baumritter, Agnieshka

AU - Daniel, Ebenezer

PY - 2015/3/1

Y1 - 2015/3/1

N2 - IMPORTANCE: Detection of treatment-requiring retinopathy of prematurity (ROP) involves serial eye examinations. An ROP prediction model using predictive factors could identify high-risk infants and reduce required eye examinations. OBJECTIVE: To determine predictive factors for the development of referral-warranted (RW) ROP. DESIGN, SETTING, AND PARTICIPANTS: This multicenter observational cohort study included secondary analysis of data from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study. Infants included in the study had a birth weight (BW) of less than 1251 g. EXPOSURES: Serial ROP examinations of premature infants who had 2 or more ROP examinations. MAIN OUTCOMES AND MEASURES: Incidence of RW-ROP (defined as the presence of plus disease, zone I ROP, or ROP stage 3 or greater in either eye) and associations with predictive factors. RESULTS: Among 979 infants without RW-ROP at first study-related eye examination (median postmenstrual age, 33 weeks; range, 29-40 weeks) who underwent at least 2 eye examinations, 149 (15.2%) developed RW-ROP. In a multivariate model, significant predictors for RW-ROP were male sex (odds ratio [OR], 1.80; 95%CI, 1.13-2.86 vs female), nonblack race (OR, 2.76; 95%CI, 1.50-5.08 for white vs black race and OR, 4.81; 95%CI, 2.19-10.6 for other vs black race), low BW(OR, 5.16; 95%CI, 1.12-7.20 for ≤500 g vs >1100 g), younger gestational age (OR, 9.79; 95%CI, 3.49-27.5 for ≤24 weeks vs ≥28 weeks), number of quadrants with preplus disease (OR, 7.12; 95%CI, 2.53-20.1 for 1-2 quadrants and OR, 18.4; 95%CI, 4.28-79.4 for 3-4 quadrants vs no preplus disease), stage 2 ROP (OR, 4.13; 95%CI, 2.13-8.00 vs no ROP), the presence of retinal hemorrhage (OR, 4.36; 95%CI, 1.57-12.1 vs absence), the need for respiratory support (OR, 4.99; 95%CI, 1.89-13.2 for the need for controlled mechanical ventilator; OR, 11.0; 95%CI, 2.26-53.8 for the need for high-frequency oscillatory ventilation vs no respiratory support), and slow weight gain (OR, 2.44; 95%CI, 1.22-4.89 for weight gain ≤12 g/d vs >18 g/d). These characteristics predicted the development of RW-ROP significantly better than BW and gestational age (area under receiver operating characteristic curve, 0.88 vs 0.78; P <.001). CONCLUSIONS AND RELEVANCE: When controlling for very low BW and prematurity, the presence of preplus disease, stage 2 ROP, retinal hemorrhage, and the need for ventilation at time of first study-related eye examination were strong independent predictors for RW-ROP. These predictors may help identify infants in need of timely eye examinations.

AB - IMPORTANCE: Detection of treatment-requiring retinopathy of prematurity (ROP) involves serial eye examinations. An ROP prediction model using predictive factors could identify high-risk infants and reduce required eye examinations. OBJECTIVE: To determine predictive factors for the development of referral-warranted (RW) ROP. DESIGN, SETTING, AND PARTICIPANTS: This multicenter observational cohort study included secondary analysis of data from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study. Infants included in the study had a birth weight (BW) of less than 1251 g. EXPOSURES: Serial ROP examinations of premature infants who had 2 or more ROP examinations. MAIN OUTCOMES AND MEASURES: Incidence of RW-ROP (defined as the presence of plus disease, zone I ROP, or ROP stage 3 or greater in either eye) and associations with predictive factors. RESULTS: Among 979 infants without RW-ROP at first study-related eye examination (median postmenstrual age, 33 weeks; range, 29-40 weeks) who underwent at least 2 eye examinations, 149 (15.2%) developed RW-ROP. In a multivariate model, significant predictors for RW-ROP were male sex (odds ratio [OR], 1.80; 95%CI, 1.13-2.86 vs female), nonblack race (OR, 2.76; 95%CI, 1.50-5.08 for white vs black race and OR, 4.81; 95%CI, 2.19-10.6 for other vs black race), low BW(OR, 5.16; 95%CI, 1.12-7.20 for ≤500 g vs >1100 g), younger gestational age (OR, 9.79; 95%CI, 3.49-27.5 for ≤24 weeks vs ≥28 weeks), number of quadrants with preplus disease (OR, 7.12; 95%CI, 2.53-20.1 for 1-2 quadrants and OR, 18.4; 95%CI, 4.28-79.4 for 3-4 quadrants vs no preplus disease), stage 2 ROP (OR, 4.13; 95%CI, 2.13-8.00 vs no ROP), the presence of retinal hemorrhage (OR, 4.36; 95%CI, 1.57-12.1 vs absence), the need for respiratory support (OR, 4.99; 95%CI, 1.89-13.2 for the need for controlled mechanical ventilator; OR, 11.0; 95%CI, 2.26-53.8 for the need for high-frequency oscillatory ventilation vs no respiratory support), and slow weight gain (OR, 2.44; 95%CI, 1.22-4.89 for weight gain ≤12 g/d vs >18 g/d). These characteristics predicted the development of RW-ROP significantly better than BW and gestational age (area under receiver operating characteristic curve, 0.88 vs 0.78; P <.001). CONCLUSIONS AND RELEVANCE: When controlling for very low BW and prematurity, the presence of preplus disease, stage 2 ROP, retinal hemorrhage, and the need for ventilation at time of first study-related eye examination were strong independent predictors for RW-ROP. These predictors may help identify infants in need of timely eye examinations.

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