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Evaluating retinopathy of prematurity screening guidelines for 24- to 27-week gestational age infants

Journal of Perinatology volume 34, pages 311–318 (2014)Cite this article

Subjects

Abstract

Objective:

To determine whether current retinopathy of prematurity (ROP) screening guidelines adequately identify treatable ROP in a contemporary cohort of extremely low gestation infants.

Study Design:

Data from the Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial were used. Inborn infants of 24 0/7 to 27 6/7 weeks gestational age (GA) with consent before delivery were enrolled in 2005 to 2009. Severe ROP (type 1 ROP or treatment with laser, cryotherapy or bevacizumab) or death was the primary outcome for the randomized trial. Examinations followed the then current AAP (American Academy of Pediatrics) screening recommendations, beginning by 31 to 33 weeks postmenstrual age (PMA).

Result:

One thousand three hundred and sixteen infants were enrolled in the trial. Nine hundred and ninety-seven of the 1121 who survived to first eye exam had final ROP outcome determined. One hundred and thirty-seven (14% of 997) met criteria for severe ROP and 128 (93%) of those had sufficient data (without missing or delayed exams) to determine age of onset of severe ROP. PMA at onset was 32.1 to 53.1 weeks. In this referral center cohort, 1.4% (14/997) developed severe ROP after discharge.

Conclusion:

Our contemporary data support the 2013 AAP screening guidelines for ROP for infants of 24 0/7 to 27 6/7 weeks GA. Some infants do not meet treatment criteria until after discharge home. Post-discharge follow-up of infants who are still at risk for severe ROP is crucial for timely detection and treatment.

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Acknowledgements

Data collected at participating sites of the National Institute of Child Health and Development Neonatal Research Network (NRN) were transmitted to RTI International, the data coordinating center (DCC) for the network, which stored, managed and analyzed the data for this study. On behalf of the NRN, Dr Abhik Das (DCC Principal Investigator), Dr Marie Gantz and Ms Wrage (DCC Statisticians) had full access to all the data in the study and take responsibility for the integrity of the data and accuracy of the data analysis.

We are indebted to our medical and nursing colleagues and the infants and their parents who agreed to take part in this study. The following investigators, in addition to those listed as authors, participated in this study:

NRN Steering Committee Chairs: Alan H Jobe, MD PhD, University of Cincinnati (2003–2006); Michael S Caplan, MD, University of Chicago, Pritzker School of Medicine (2006–2011).

Alpert Medical School of Brown University and Women & Infants Hospital of Rhode Island (U10 HD27904)—William Oh, MD; Betty R Vohr, MD; Angelita M Hensman, RN BSN; Bonnie E Stephens, MD; Barbara Alksninis, PNP; Dawn Andrews, RN; Kristen Angela, RN; Susan Barnett, RRT; Bill Cashore, MD; Melinda Caskey, MD; Kim Francis, RN; Dan Gingras, RRT; Regina A Gargus, MD FAAP; Katharine Johnson, MD; Shabnam Lainwala, MD; Theresa M Leach, MEd CAES; Martha R Leonard, BA BS; Sarah Lillie, RRT; Kalida Mehta; James R Moore, MD; Lucy Noel; Suzy Ventura; Rachel V Walden; Victoria E Watson, MS CAS.

Case Western Reserve University, Rainbow Babies & Children’s Hospital (U10 HD21364, M01 RR80)—Avroy A Fanaroff, MD; Deanne E Wilson-Costello, MD; Bonnie S Siner, RN; Arlene Zadell RN; Julie DiFiore, BS; Monika Bhola, MD; Harriet G. Friedman, MA; Gulgun Yalcinkaya, MD.

Cincinnati Children’s Hospital Medical Center, University of Cincinnati Hospital and Good Samaritan Hospital (U10 HD27853, M01 RR8084)—Edward F Donovan, MD; Vivek Narendran, MD MRCP; Kimberly Yolton, PhD; Kate Bridges, MD; Barbara Alexander, RN; Cathy Grisby, BSN CCRC; Marcia Worley Mersmann, RN CCRC; Holly L Mincey, RN BSN; Jody Hessling, RN; Teresa L Gratton, PA.

Duke University School of Medicine, University Hospital, Alamance Regional Medical Center and Durham Regional Hospital (U10 HD40492, M01 RR30)—Ronald N Goldberg, MD; C Michael Cotten, MD MHS; Ricki F Goldstein, MD; Patricia Ashley, MD; Kathy J Auten, MSHS; Kimberley A Fisher, PhD FNP-BC IBCLC; Katherine A Foy, RN; Sharon F Freedman, MD; Kathryn E Gustafson, PhD; Melody B Lohmeyer, RN MSN; William F Malcolm, MD; David K Wallace, MD MPH.

Emory University, Children’s Healthcare of Atlanta, Grady Memorial Hospital and Emory Crawford Long Hospital (U10 HD27851, RR25008, M01 RR39)—Barbara J Stoll, MD; Susie Buchter, MD; Anthony J Piazza, MD; David P Carlton, MD; Ira Adams-Chapman, MD; Linda Black, MD; Ann M Blackwelder, RNC BS MS; Sheena Carter, PhD; Elisabeth Dinkins, PNP; Sobha Fritz, PhD; Ellen C Hale, RN BS CCRC; Amy K Hutchinson, MD; Maureen Mulligan LaRossa, RN; Gloria V Smikle, PNP MSN.

Eunice Kennedy Shriver National Institute of Child Health and Human Development—Stephanie Wilson Archer, MA.

Indiana University, University Hospital, Methodist Hospital, Riley Hospital for Children, and Wishard Health Services (U10 HD27856, M01 RR750)—Brenda B Poindexter, MD MS; Anna M Dusick, MD FAAP; James A Lemons, MD; Leslie D Wilson, BSN CCRC; Faithe Hamer, BS; Ann B Cook, MS; Dianne E Herron, RN; Carolyn Lytle, MD MPH; Heike M Minnich, PsyD HSPP.

National Heart, Lung, and Blood Institute—Mary Anne Berberich, PhD; Carol J Blaisdell, MD; Dorothy B Gail, PhD; James P Kiley, PhD.

RTI International (U10 HD36790)—W Kenneth Poole, PhD; Jamie E Newman, PhD MPH; Betty K Hastings; Jeanette O’Donnell Auman, BS; Carolyn Petrie Huitema, MS; James W Pickett II, BS; Dennis Wallace, PhD; Kristin M Zaterka-Baxter, RN BSN.

Stanford University and Lucile Packard Children’s Hospital (U10 HD27880, UL1 RR25744, M01 RR70)—Krisa P Van Meurs, MD; David K Stevenson, MD; Susan R Hintz, MD MS Epi; M Bethany Ball, BS CCRC; Barbara Bentley, PsychD MSEd; Elizabeth F Bruno, PhD; Alexis S Davis, MD MS; Maria Elena DeAnda, PhD; Anne M DeBattista, RN, PNP; Jean G Kohn, MD MPH; Melinda S Proud, RCP; Renee P Pyle, PhD; Nicholas H St. John, PhD; Hali E Weiss, MD.

Tufts Medical Center, Floating Hospital for Children (U10 HD53119, M01 RR54)—Ivan D Frantz III, MD; Elisabeth C McGowan, MD; John M Fiascone, MD; Anne Furey, MPH; Brenda L MacKinnon, RNC; Ellen Nylen, RN BSN; Ana Brussa, MS OTR/L; Cecelia Sibley, PT MHA.

University of Alabama at Birmingham Health System and Children’s Hospital of Alabama (U10 HD34216, M01 RR32)—Namasivayam Ambalavanan, MD; Myriam Peralta-Carcelen, MD MPH; Monica V Collins, RN BSN MaEd; Shirley S Cosby, RN BSN; Vivien A Phillips, RN BSN; Kirstin J Bailey, PhD; Fred J Biasini, PhD; Maria Hopkins, PhD; Kristen C Johnston, MSN CRNP; Sara Krzywanski, MS; Kathleen G Nelson, MD; Cryshelle S Patterson, PhD; Richard V Rector, PhD; Leslie Rodriguez, PhD; Amanda Soong, MD; Sally Whitley, MA OTR-L FAOTA; Sheree York, PT DPT MS PCS.

University of California—San Diego Medical Center and Sharp Mary Birch Hospital for Women (U10 HD40461)—Maynard R Rasmussen, MD; Paul R Wozniak, MD; Yvonne E Vaucher, MD MPH; Wade Rich, RRT; Kathy Arnell, RNC; Rene Barbieri-Welge; Ayala Ben-Tall; Renee Bridge, RN; Clarence Demetrio, RN; Martha G Fuller, RN MSN; Elaine Ito; Meghan Lukasik; Deborah Pontillo; Donna Posin, OTR/L MPA; Cheryl Runyan; James Wilkes; Paul Zlotnik.

University of Iowa Children’s Hospital (U10 HD53109, UL1 RR24979, M01 RR59)—Edward F Bell, MD; John A Widness, MD; Michael J Acarregui, MD; Jonathan M Klein, MD; Tarah T Colaizy, MD MPH; Karen J Johnson, RN BSN; Diane L Eastman, RN CPNP MA.

University of Miami, Holtz Children’s Hospital (U10 HD21397, M01 RR16587)—Shahnaz Duara, MD; Charles R Bauer, MD; Ruth Everett-Thomas, RN MSN; Maria Calejo, MEd; Alexis N Diaz, BA; Silvia M Frade Eguaras, BA; Andrea Garcia, MA; Kasey Hamlin-Smith, PhD; Michelle Harwood Berkowits, PhD; Sylvia Hiriart-Fajardo, MD; Elaine O Mathews, RN; Helina Pierre, BA; Arielle Riguard, MD; Alexandra Stroerger, BA.

University of New Mexico Health Sciences Center (U10 HD53089, M01 RR997)—Kristi L Watterberg, MD; Robin K Ohls, MD; Janell Fuller, MD; Julie Rohr, MSN RNC CNS; Conra Backstrom Lacy, RN; Jean Lowe, PhD; Rebecca Montman, BSN.

University of Rochester Medical Center, Golisano Children’s Hospital (U10 HD40521, M01 RR44)—Nirupama Laroia, MD; Gary David Markowitz, MD; Gary J Myers, MD; Linda J Reubens, RN CCRC; Diane Hust, MS RN CS; Lisa Augostino; Julie Babish Johnson, MSW; Erica Burnell, RN; Rosemary L Jensen; Emily Kushner, MA; Joan Merzbach, LMSW; Kelley Yost, PhD.

University of Texas Southwestern Medical Center at Dallas, Parkland Health & Hospital System, and Children’s Medical Center Dallas (U10 HD40689, M01 RR633)—Pablo J Sánchez, MD; Charles R Rosenfeld, MD; Walid A Salhab, MD; Roy J Heyne, MD; Sally S Adams, MS RN CPNP; James Allen, RRT; Laura Grau, RN; Alicia Guzman; Gaynelle Hensley, RN; Elizabeth T Heyne, PsyD PA-C; Melissa H Lepps, RN; Linda A Madden, RN CPNP; Melissa Martin, RN; Nancy A Miller, RN; Janet S Morgan, RN; Araceli Solis, RRT; Lizette E Torres, RN; Catherine Twell Boatman, MS CIMI; Diana M Vasil, RNC-NIC; Kerry Wilder, RN.

University of Texas Health Science Center at Houston Medical School and Children’s Memorial Hermann Hospital (U10 HD21373)—Jon E Tyson, MD MPH; Patricia W Evans, MD; Nora I Alaniz, BS; Patricia Evans, MD; Beverly Foley Harris, RN BSN; Charles Green, PhD; Margarita Jiminez, MD MPH; Anna E Lis, RN BSN; Sarah Martin, RN BSN; Georgia E McDavid, RN; Brenda H Morris, MD; Margaret L Poundstone, RN BSN; Stacy Reddoch, BA; Saba Siddiki, MD; Patti L Pierce Tate, RCP; Laura L Whitely, MD; Sharon L Wright, MT (ASCP).

University of Utah Medical Center, Intermountain Medical Center, LDS Hospital, and Primary Children’s Medical Center (U10 HD53124, M01 RR64)—Anna Bodnar, MD; Shawna Baker, RN; Karie Bird, RN; Jill Burnett, RN; Laura Cole, RN; Karen A Osborne, RN BSN CCRC; Cynthia Spencer, RNC; Mike Steffens, PhD; Kimberlee Weaver-Lewis, RN BSN; Karen Zanetti, RN.

Wake Forest University, Baptist Medical Center, Brenner Children’s Hospital, and Forsyth Medical Center (U10 HD40498, M01 RR7122)—T Michael O’Shea, MD MPH; Robert G Dillard, MD; Lisa K Washburn, MD; Nancy J Peters, RN CCRP; Barbara G Jackson, RN BSN; Korinne Chiu, MA; Deborah Evans Allred, MA LPA; Donald J Goldstein, PhD; Raquel Halfond, MA; Carroll Peterson, MA; Ellen L Waldrep, MS; Cherrie D Welch, MD MPH; Melissa Whalen Morris, MA; Gail Wiley Hounshell, PhD.

Wayne State University, Hutzel Women’s Hospital, and Children’s Hospital of Michigan (U10 HD21385)—Seetha Shankaran, MD; Beena G Sood, MD MS; Athina Pappas, MD; Rebecca Bara, RN BSN; Elizabeth Billian, RN MBA; Laura A Goldston, MA; Mary Johnson, RN BSN.

Yale University, Yale-New Haven Children’s Hospital, and Bridgeport Hospital (U10 HD27871, UL1 RR24139, MO1 RR125)—Richard A Ehrenkranz, MD; Vineet Bhandari, MD DM; Harris C Jacobs, MD; Pat Cervone, RN; Patricia Gettner, RN; Monica Konstantino, RN BSN; JoAnn Poulsen, RN; Janet Taft, RN BSN; Christine G Butler, MD; Nancy Close, PhD; Walter Gilliam, PhD; Sheila Greisman, RN; Elaine Romano, MSN; Joanne Williams, RN BSN.

Data and Safety Monitoring Committee—Gordon Avery, MD, chair, Children’s National Medical Center; Christine A Gleason, MD, chair, University of Washington; Marilee C Allen, MD, Johns Hopkins University School of Medicine; Shrikant I Bangdiwala, PhD, University of North Carolina; Carol J Blaisdell, MD, National Heart, Lung, and Blood Institute; Robert J Boyle, MD, University of Virginia Health System; Traci Clemons, PhD, The EMMES Corporation; Mary E D’Alton, MD, Columbia University; Abhik Das (ex officio), PhD, RTI International; Dorothy B Gail, PhD, National Heart, Lung, and Blood Institute; Carl Hunt, MD, National Heart, Lung, and Blood Institute; Martin Keszler, MD, Georgetown University Hospital; W Kenneth Poole (ex officio), PhD, RTI International; Carol K Redmond, ScD, University of Pittsburg; Michael G Ross, MD, MPH; UCLA School of Medicine and Public Health; Merran A Thomson, MD, Hammersmith Hospital, UK; Steven J Weiner, MS, The George Washington University; Marian Willinger (ex officio), PhD, Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Retinopathy of Prematurity Adjudication Committee—Gary David Markowitz, MD, University of Rochester; Amy K Hutchinson, MD, Emory University; David K Wallace, MD, MPH, Duke University; Sharon F Freedman, MD, Duke University.

Funding source: The National Institutes of Health, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), and the National Heart, Lung, and Blood Institute (NHLBI) provided grant support for the Neonatal Research Network’s SUPPORT trial.

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Authors and Affiliations

  1. Department of Pediatrics, University of Texas Medical School at Houston, Houston, TX, USA

    K A Kennedy

  2. Biostatistics and Epidemiology Division, RTI International, Research Triangle Park, NC, USA

    L A Wrage & M G Gantz

  3. Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA

    R D Higgins

  4. Department of Pediatrics, University of California at San Diego, San Diego, CA, USA

    N N Finer

  5. Division of Neonatology, University of Alabama at Birmingham, Birmingham, AL, USA

    W A Carlo

  6. Department of Pediatrics, Rainbow Babies & Children’s Hospital, Case Western Reserve University, Cleveland, OH, USA

    M C Walsh & N S Newman

  7. Department of Pediatrics, Women & Infants Hospital, Brown University, Providence, RI, USA

    A R Laptook

  8. Department of Pediatrics, Division of Neonatology, University of Utah School of Medicine, Salt Lake City, UT, USA

    R G Faix & B A Yoder

  9. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA

    K Schibler

  10. Biostatistics and Epidemiology Division, RTI International, Rockville, MD, USA

    A Das

  11. Department of Pediatrics, University of Rochester Medical Center, Rochester, NY, USA

    D L Phelps

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for the SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network

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Correspondence to K A Kennedy.

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Kennedy, K., Wrage, L., Higgins, R. et al. Evaluating retinopathy of prematurity screening guidelines for 24- to 27-week gestational age infants. J Perinatol 34, 311–318 (2014). https://doi.org/10.1038/jp.2014.12

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