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Fares A, Abdelmonaim S, Sayed D, Sadek S, Abdulrazek A, Helmy Y, Maher S. Validation of WINROP algorithm as screening tool of retinopathy of prematurity among Egyptian preterm neonates. Eye (Lond) 2024; 38:1562-1566. [PMID: 38310200 PMCID: PMC11126399 DOI: 10.1038/s41433-024-02953-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 12/09/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness worldwide. Proper screening for ROP can prevent loss of vision. WINROP (weight, insulin-like growth factor 1, neonatal, retinopathy of prematurity) is an online surveillance system based on gestational age, birth weight and weekly weight gain that can predict infants at risk of sight-threatening retinopathy of prematurity. AIMS To evaluate the diagnostic accuracy of WINROP algorithm in detecting sight-threatening ROP in Egyptian preterm neonates. METHODS Birth weight (BW), gestational age (GA) and weekly weight measurement of 365 preterm infants were prospectively entered into WINROP algorithm. Based on these inputs, the algorithm would output and a screening was performed as is standard. Sensitivity, specificity, and predictive values were calculated by comparing WINROP outcomes with ROP screening outcomes. RESULTS Of the infants included in the study the mean GA was ±31.24 and mean BW was ±1508.78. A high risk WINROP alarm was triggered in 62 infants of whom 16 infants develop type 1 or type 2 ROP. These infants had associated comorbidities including sepsis, Intraventricular hemorrhage (IVH), Necrotizing enterocolitis (NEC), history of transfusion of packed red blood cells (RBCS) and history of platelet transfusion. A low risk WINROP alarm was triggered in 303 infants of whom 15 infants developed type 1 or type 2ROP. WINROP showed a sensitivity of 51.6%, a specificity of 86.2%, a positive predictive value (PPV) of 52.8% and a negative predictive value (NPV) of 95% for detection of type 1 or type 2 ROP. CONCLUSION WINROP has low sensitivity and high specificity for detection of ROP. It may help in ROP prediction but can't be used alone. Modification of WINROP algorithm taking into account other risk factors may improve sensitivity and reduce number for ROP examination.
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Affiliation(s)
- Asmaa Fares
- Pediatrics Department, Cairo University, Cairo, Egypt
- El Galaa Teaching Hospital, The general organization of teaching hospitals and institutes, Cairo, Egypt
| | | | - Dina Sayed
- Pediatrics Department, Cairo University, Cairo, Egypt
| | - Sherin Sadek
- Ophthalmology Department, Fayoum University, Cairo, Egypt
| | | | - Youssef Helmy
- Ophthalmology Department, Cairo University, Cairo, Egypt
| | - Sara Maher
- Ophthalmology Department, Cairo University, Cairo, Egypt.
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Neumann RP, Gerull R, Hasler PW, Wellmann S, Schulzke SM. Vasoactive peptides as biomarkers for the prediction of retinopathy of prematurity. Pediatr Res 2024; 95:1868-1874. [PMID: 38402317 PMCID: PMC11245386 DOI: 10.1038/s41390-024-03091-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/27/2023] [Accepted: 01/28/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Retinopathy of prematurity (ROP) is a major complication in preterm infants. We assessed if plasma levels of midregional pro-atrial natriuretic peptide (MR-proANP) and C-terminal pro-endothelin-1 (CT-proET1) serve as early markers for subsequent ROP development in preterm infants <32 weeks gestation. METHODS Prospective, two-centre, observational cohort study. MR-proANP and CT-proET1 were measured on day seven of life. Associations with ROP ≥ stage II were investigated by univariable and multivariable logistic regression models. RESULTS We included 224 infants born at median (IQR) 29.6 (27.1-30.8) weeks gestation and birth weight of 1160 (860-1435) g. Nineteen patients developed ROP ≥ stage II. MR-proANP and CT-proET1 levels were higher in these infants (median (IQR) 864 (659-1564) pmol/L and 348 (300-382) pmol/L, respectively) compared to infants without ROP (median (IQR) 299 (210-502) pmol/L and 196 (156-268) pmol/L, respectively; both P < 0.001). MR-proANP and CT-proET1 levels were significantly associated with ROP ≥ stage II in univariable logistic regression models and after adjusting for co-factors, including gestational age and birth weight z-score. CONCLUSIONS MR-proANP and CT-proET1 measured on day seven of life are strongly associated with ROP ≥ stage II in very preterm infants and might improve early prediction of ROP in the future. IMPACT Plasma levels of midregional pro-atrial natriuretic peptide and C-terminal pro-endothelin-1 measured on day seven of life in very preterm infants show a strong association with development of retinopathy of prematurity ≥ stage II. Both biomarkers have the potential to improve early prediction of retinopathy of prematurity. Vasoactive peptides might allow to reduce the proportion of screened infants substantially.
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Affiliation(s)
- Roland P Neumann
- Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland.
| | - Roland Gerull
- Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
- Division of Neonatology, University Children's Hospital Inselspital Berne, Berne, Switzerland
| | - Pascal W Hasler
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Sven Wellmann
- Department of Neonatology, University Children's Hospital Regensburg (KUNO), Hospital St. Hedwig of the Order of St. John, University of Regensburg, Regensburg, Germany
| | - Sven M Schulzke
- Department of Neonatology, University Children's Hospital Basel UKBB, University of Basel, Basel, Switzerland
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Zhang L, Buonfiglio F, Fieß A, Pfeiffer N, Gericke A. Retinopathy of Prematurity-Targeting Hypoxic and Redox Signaling Pathways. Antioxidants (Basel) 2024; 13:148. [PMID: 38397746 PMCID: PMC10885953 DOI: 10.3390/antiox13020148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/25/2024] Open
Abstract
Retinopathy of prematurity (ROP) is a proliferative vascular ailment affecting the retina. It is the main risk factor for visual impairment and blindness in infants and young children worldwide. If left undiagnosed and untreated, it can progress to retinal detachment and severe visual impairment. Geographical variations in ROP epidemiology have emerged over recent decades, attributable to differing levels of care provided to preterm infants across countries and regions. Our understanding of the causes of ROP, screening, diagnosis, treatment, and associated risk factors continues to advance. This review article aims to present the pathophysiological mechanisms of ROP, including its treatment. Specifically, it delves into the latest cutting-edge treatment approaches targeting hypoxia and redox signaling pathways for this condition.
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Affiliation(s)
| | | | | | | | - Adrian Gericke
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany; (L.Z.); (F.B.); (A.F.); (N.P.)
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Bunyavee C, Hemarat K. Accuracy of the postnatal growth and retinopathy of prematurity screening criteria in predicting prethreshold retinopathy of prematurity in the tertiary hospital, Bangkok, Thailand. Taiwan J Ophthalmol 2023; 13:535-539. [PMID: 38249513 PMCID: PMC10798389 DOI: 10.4103/tjo.tjo-d-23-00027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/23/2023] [Accepted: 05/01/2023] [Indexed: 01/23/2024] Open
Abstract
PURPOSE The postnatal growth and retinopathy of prematurity (G-ROP), retinopathy of prematurity (ROP) predictive model, was developed in North America with high sensitivity and fewer infants examined. This study aimed to validate this model in Thai infants by assessing sensitivity and comparing it to the current American Academy of Ophthalmology (AAO) screening guideline. MATERIALS AND METHODS The records of infants screened for ROP were retrospectively reviewed from 2015 to 2020. G-ROP model was applied to calculate sensitivity for prethreshold type 1 and 2 ROP and the reduction of the number of infants examined. RESULTS Of 129 infants screened, there were 102 infants who met G-ROP criteria. The mean gestational age at birth was 29.7 ± 2.7 weeks. The mean birth weight was 1177.8 ± 401.3 g. Both G-ROP and AAO detected prethreshold type 1 ROP in 24 of 24 infants (sensitivity, 100%; 95% confidence interval [CI], 85.8%-100%). Furthermore, they detected all four infants prethreshold type 2 ROP with 100% of sensitivity (95% CI, 39.8-100.0). The reduction in infants receiving examinations using G-ROP was 20.9%. CONCLUSIONS G-ROP model provided high sensitivity and lessen unnecessary examinations for ROP screening in Thai infants.
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Affiliation(s)
- Chavisa Bunyavee
- Department of Ophthalmology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
| | - Kornwipa Hemarat
- Department of Ophthalmology, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand
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Patel NA, Hoyek S, Al-Khersan H, Fan KC, Yannuzzi NA, Davila J, Berrocal AM. Retinopathy of Prematurity Outcomes of Neonates Meeting Only a Single Screening Criterion: Proposal of the TWO-ROP Algorithm. Am J Ophthalmol 2023; 252:147-152. [PMID: 36933856 DOI: 10.1016/j.ajo.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To assess the rates of retinopathy of prematurity (ROP) and treatment-warranted ROP in a modern set of patients meeting 0 or 1 of the current ROP screening criteria. DESIGN Retrospective cohort study. METHODS Single-center study of 9350 infants screened for ROP from 2009 to 2019. Rates of ROP and treatment-warranted ROP were evaluated in group 1 (birth weight [BW] <1500 g and gestational age [GA] ≥30 weeks), group 2 (BW ≥1500 g and GA <30 weeks), and group 3 (BW ≥1500 g and GA ≥30 weeks). RESULTS Of 7520 patients with reported BW and GA, 1612 (21.4%) patients met the inclusion criteria. The number of patients in groups 1, 2, and 3 was 466 (6.19%), 23 (0.31%), and 1123 (14.93%), respectively. The number of patients diagnosed with ROP was 20 (4.29%) in group 1, 1 (4.35%) in group 2, and 12 (1.07%) in group 3 (P < .001). The mean interval between birth and ROP diagnosis was 36.25 days (range 12-75 days) in group 1, 47 days in group 2, and 23.33 days (range 10-39 days) in group 3 (P = .05). No cases of stage 3, zone 1, or plus disease were recorded. No patients met the treatment criteria. CONCLUSIONS Patients meeting 1 screening criterion had a low rate of ROP (<5%), with no stage 3, zone 1, or plus disease. No patients required treatment. We propose a possible algorithm (TWO-ROP) in appropriate neonatal intensive care units, with an amendment in screening protocol for this low-risk population to include only an outpatient screening examination within 1 week of discharge, or at 40 weeks if inpatient, to decrease the inpatient ROP screening burden while maintaining safety. Further external validation of this protocol would be required.
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Affiliation(s)
- Nimesh A Patel
- From the Department of Ophthalmology (N.A.P., S.H., J.D.) Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; Bascom Palmer Eye Institute (N.A.P., H.A-K., K.C.F., N.A.Y., A.M.B.) University of Miami Leonard M. Miller School of Medicine, Miami, Florida; Department of Ophthalmology (N.A.P.), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
| | - Sandra Hoyek
- From the Department of Ophthalmology (N.A.P., S.H., J.D.) Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Hasenin Al-Khersan
- Bascom Palmer Eye Institute (N.A.P., H.A-K., K.C.F., N.A.Y., A.M.B.) University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Kenneth C Fan
- Bascom Palmer Eye Institute (N.A.P., H.A-K., K.C.F., N.A.Y., A.M.B.) University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Nicolas A Yannuzzi
- Bascom Palmer Eye Institute (N.A.P., H.A-K., K.C.F., N.A.Y., A.M.B.) University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Jose Davila
- From the Department of Ophthalmology (N.A.P., S.H., J.D.) Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Audina M Berrocal
- Bascom Palmer Eye Institute (N.A.P., H.A-K., K.C.F., N.A.Y., A.M.B.) University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Berrocal AM, Fan KC, Al-Khersan H, Negron CI, Murray T. Retinopathy of Prematurity: Advances in the Screening and Treatment of Retinopathy of Prematurity Using a Single Center Approach. Am J Ophthalmol 2022; 233:189-215. [PMID: 34298009 PMCID: PMC8697761 DOI: 10.1016/j.ajo.2021.07.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 06/30/2021] [Accepted: 07/15/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To focus on the longitudinal evaluation of high-risk infants for the development of retinopathy of prematurity (ROP) at a single tertiary neonatal intensive care unit (NICU), and to evaluate evolving demographics of ROP and the transition of treatment-warranted disease. DESIGN Retrospective cohort study. METHODS A consecutive retrospective review was performed of all infants screened for ROP between 1990 and 2019 at the Jackson Memorial Hospital neonatal intensive care unit. All inborn infants meeting a birth criteria of <32 weeks' gestational age (GA) or a birthweight (BW) of 1500 g were included. Longitudinal demographic, diagnostic, and treatment data were reported. RESULTS Between January 1, 1990, and June 20, 2019, a total of 25,567 examinations were performed and 7436 patients were included. Longitudinal trends over 3 decades demonstrated a decreasing incidence of ROP (P < .05). Although the mean BW and GA increased over 3 decades, patients with ROP demonstrated lower BW and GA over time (P < .05). The prevalence of micro-premature infants (as defined by BW <750 g) continues to rise over time. Micro-preemies demonstrated increasing severity of zone and stage grading, plus disease, and propensity to require treatment (P < .05). The rate of progression of ROP to stage 4 and 5 disease has decreased over time, and there has been an associated increased adoption of intravitreal bevacizumab as primary and salvage therapy. CONCLUSIONS Understanding the evolution of ROP infants and treatment over time is critical in identifying high-risk infants and in reducing the incidence of severe-stage ROP. Micro-prematurity is one of the significant risk factors for treatment-warranted ROP that continues to increase as neonatal care improves. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Audina M Berrocal
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA.
| | - Kenneth C Fan
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Hasenin Al-Khersan
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Catherin I Negron
- Department of Ophthalmology (A.M.B, K.C.F., H.A.-K., C.I.N.), Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Timothy Murray
- Murray Oncology and Retina (T.M.), South Miami, Florida, USA
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Athikarisamy S, Desai S, Patole S, Rao S, Simmer K, Lam GC. The Use of Postnatal Weight Gain Algorithms to Predict Severe or Type 1 Retinopathy of Prematurity: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2135879. [PMID: 34812847 PMCID: PMC8611486 DOI: 10.1001/jamanetworkopen.2021.35879] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
IMPORTANCE The currently recommended method for screening for retinopathy of prematurity (ROP) is binocular indirect ophthalmoscopy, which requires frequent eye examinations entailing a heavy clinical workload. Weight gain-based algorithms have the potential to minimize the need for binocular indirect ophthalmoscopy and have been evaluated in different setups with variable results to predict type 1 or severe ROP. OBJECTIVE To synthesize evidence regarding the ability of postnatal weight gain-based algorithms to predict type 1 or severe ROP. DATA SOURCES PubMed, MEDLINE, Embase, and the Cochrane Library databases were searched to identify studies published between January 2000 and August 2021. STUDY SELECTION Prospective and retrospective studies evaluating the ability of these algorithms to predict type 1 or severe ROP were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data. This meta-analysis was performed according to the Cochrane guidelines and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines. MAIN OUTCOMES AND MEASURES Ability of algorithms to predict type 1 or sever ROP was measured using statistical indices (pooled sensitivity, specificity, and summary area under the receiver operating characteristic curves, as well as pooled negative likelihood ratios and positive likelihood ratios and diagnostic odds ratios). RESULTS A total of 61 studies (>37 000 infants) were included in the meta-analysis. The pooled estimates for sensitivity and specificity, respectively, were 0.89 (95% CI, 0.85-0.92) and 0.57 (95% CI, 0.51-0.63) for WINROP (Weight, IGF-1 [insulinlike growth factor 1], Neonatal, ROP), 1.00 (95% CI, 0.88-1.00) and 0.60 (95% CI, 0.15-0.93) for G-ROP (Postnatal Growth and ROP), 0.95 (95% CI, 0.71-0.99) and 0.52 (95% CI, 0.36-0.68) for CHOP ROP (Children's Hospital of Philadelphia ROP), 0.99 (95% CI, 0.73-1.00) and 0.49 (95% CI, 0.03-0.74) for ROPScore, 0.98 (95% CI, 0.94-0.99) and 0.35 (95% CI, 0.22-0.51) for CO-ROP (Colorado ROP). The original PINT (Premature Infants in Need of Transfusion) ROP study reported a sensitivity of 0.98 (95% CI, 0.91-0.99) and a specificity of 0.36 (95% CI, 0.30-0.42). The pooled negative likelihood ratios were 0.19 (95% CI, 0.13-0.27) for WINROP, 0.0 (95% CI, 0.00-0.32) for G-ROP, 0.10 (95% CI, 0.02-0.53) for CHOP ROP, 0.03 (95% CI, 0.00-0.77) for ROPScore, and 0.07 (95% CI, 0.03-0.16) for CO-ROP. The pooled positive likelihood ratios were 2.1 (95% CI, 1.8-2.4) for WINROP, 2.5 (95% CI, 0.7-9.1) for G-ROP, 2.0 (95% CI, 1.5-2.6) for CHOP ROP, 1.9 (95% CI, 1.1-3.3) for ROPScore, and 1.5 (95% CI, 1.2-1.9) for CO-ROP. CONCLUSIONS AND RELEVANCE This study suggests that weight gain-based algorithms have adequate sensitivity and negative likelihood ratios to provide reasonable certainty in ruling out type 1 ROP or severe ROP. Given the implications of missing even a single case of severe ROP, algorithms with very high sensitivity (close to 100%) and low negative likelihood ratios (close to zero) need to be chosen to safely reduce the number of unnecessary examinations in infants at lower risk of severe ROP.
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Affiliation(s)
- Sam Athikarisamy
- Neonatal Directorate, Perth Children’s Hospital and King Edward Memorial Hospital for Women, Perth, Australia
- School of Medicine, University of Western Australia, Crawley, Australia
| | - Saumil Desai
- Neonatal Directorate, Perth Children’s Hospital and King Edward Memorial Hospital for Women, Perth, Australia
| | - Sanjay Patole
- Neonatal Directorate, Perth Children’s Hospital and King Edward Memorial Hospital for Women, Perth, Australia
- School of Medicine, University of Western Australia, Crawley, Australia
| | - Shripada Rao
- Neonatal Directorate, Perth Children’s Hospital and King Edward Memorial Hospital for Women, Perth, Australia
- School of Medicine, University of Western Australia, Crawley, Australia
| | - Karen Simmer
- School of Medicine, University of Western Australia, Crawley, Australia
| | - Geoffrey C. Lam
- Department of Ophthalmology, Perth Children’s Hospital, Perth, Australia
- Centre for Ophthalmology and Visual Science, University of Western Australia, Crawley, Australia
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Thomas D, Madathil S, Thukral A, Sankar MJ, Chandra P, Agarwal R, Deorari A. Diagnostic Accuracy of WINROP, CHOP-ROP and ROPScore in Detecting Type 1 Retinopathy of Prematurity. Indian Pediatr 2021; 58:915-921. [PMID: 34016801 PMCID: PMC8549580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/27/2020] [Accepted: 05/12/2021] [Indexed: 08/18/2024]
Abstract
BACKGROUND Algorithms for predicting retinopathy of prematurity (ROP) requiring treatment need to be validated in Indian settings to determine if the burden of screening can be reduced without compromising the sensitivity of existing gestation and weight-based cut offs. OBJECTIVE To evaluate the performance of the available algorithms namely, WINROP (Weight, Insulin-like growth factor I, Neonatal ROP), CHOP-ROP (Children's Hospital of Philadelphia ROP) and ROPScore in predicting type 1 ROP and time from alarm to treatment by each algorithm. STUDY DESIGN Ambispective observational. SETTING Tertiary care neonatal intensive care unit in India. PARTICIPANTS Neonates less than 32 weeks or less than 1500 g born between July, 2013 to June, 2019 (N=578), who underwent ROP screening. PRIMARY OUTCOME Sensitivity, specificity and time from alarm to treatment by each algorithm. RESULTS The sensitivity and specificity of WINROP was 85% and 36%, for CHOP-ROP it was 54% and 71%, and for ROPScore it was 73% and 67%, respectively in detecting type 1 ROP. A total of 50/51 (98%) of neonates with type 1 ROP underwent treatment at median gestation of 9 weeks and median time from alarm to treatment by WINROP, CHOP-ROP and ROPScore was 7, 7 and 3 weeks, respectively. CONCLUSION WINROP, CHOP-ROP and ROPScore were not sensitive enough to replace the gestational age, weight and risk factor-based screening criteria for type 1 ROP.
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Affiliation(s)
- Deena Thomas
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
| | - Shamnad Madathil
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
| | - Anu Thukral
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi. Correspondence to: Dr Anu Thukral, Associate Professor, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi 110029.
| | - M Jeeva Sankar
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
| | - Parijat Chandra
- Department of Ophthalmology, Dr. Rajendra Prasad Center for Ophthalmic Sciences, New Delhi
| | - Ramesh Agarwal
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
| | - Ashok Deorari
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi
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Thomas D, Madathil S, Thukral A, Sankar MJ, Chandra P, Agarwal R, Deorari A. Diagnostic Accuracy of WINROP, CHOP-ROP and ROPScore in Detecting Type 1 Retinopathy of Prematurity. Indian Pediatr 2021. [PMID: 34016801 PMCID: PMC8549580 DOI: 10.1007/s13312-021-2321-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Algorithms for predicting retinopathy of prematurity (ROP) requiring treatment need to be validated in Indian settings to determine if the burden of screening can be reduced without compromising the sensitivity of existing gestation and weight-based cut offs. Objective To evaluate the performance of the available algorithms namely, WINROP (Weight, Insulin-like growth factor I, Neonatal ROP), CHOP-ROP (children’s Hospital of Philadelphia ROP) and ROPScore in predicting type 1 ROP and time from alarm to treatment by each algorithm. Study design Ambispective observational. Setting Tertiary care neonatal intensive care unit in India. Participants Neonates less than 32 weeks or less than 1500 g born between July, 2013 to June, 2019 (N=578), who underwent ROP screening. Primary outcome Sensitivity, specificity and time from alarm to treatment by each algorithm. Results The sensitivity and specificity of WINROP was 85% and 36%, for CHOP-ROP it was 54% and 71%, and for ROPScore it was 73% and 67%, respectively in detecting type 1 ROP. A total of 50/51 (98%) of neonates with type 1 ROP underwent treatment at median gestation of 9 weeks and median time from alarm to treatment by WINROP, CHOP-ROP and ROPScore was 7, 7 and 3 weeks, respectively. Conclusion WINROP, CHOP-ROP and ROPScore were not sensitive enough to replace the gestational age, weight and risk factor-based screening criteria for type 1 ROP.
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Guo Z, Ma N, Wu Y, Yuan H, Luo W, Zeng L, Jie H, Li S. The safety and feasibility of the screening for retinopathy of prematurity assisted by telemedicine network during COVID-19 pandemic in Wuhan, China. BMC Ophthalmol 2021; 21:258. [PMID: 34112134 PMCID: PMC8192130 DOI: 10.1186/s12886-021-02018-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 05/19/2021] [Indexed: 11/24/2022] Open
Abstract
Background During the coronavirus disease 2019 (COVID-19) epidemic, due to the traffic blockade and the shortage of medical resources, more and more premature infants could not receive timely and effective ROP screening, which delayed treatment and even caused children blindness. Therefore, how to carry out ROP screening safely and effectively during the epidemic was very important and urgent. This study aimed to evaluate the safety and feasibility of ROP screening assisted by telemedicine network during COVID-19 outbreak. Methods This retrospective study was conducted at Wuhan Children’s hospital in Wuhan, China, from January to October, 2020. The measures which were performed to make the ROP screening more safe and effective were summarized and the comparison between ROP screening assisted by telemedicine network in 2020 and usual screening in 2019 were analyzed. Results A total of 267 outpatient infants completed ROP screening. The median gestational age was 32 weeks (30w to 34w) and the median birth weight was 1780 g (1460 g to 2100 g). Meanwhile, 149 (55.8%) out of 267 infants were males. During January to May in 2020, 86 screening appointments were received, among which 67 (77.9%) were from telemedicine platform online. The completing percentage of total online ROP appointments was higher than that of total face-to-face appointments (58.1% VS 22. 1%, P = 0.018). As for the number of infants screened between 2020 and 2019 from Februaryto October, 54 infants completed ROP screening in 2020, which was higher than that (51participants) in 2019 on September. Furthermore, compared with the usual screening in 2019, ROP screening assisted by telemedicine network in 2020 had smaller gestational age (32w VS 33w, p<0.001) and lower birth weight (1780 g VS 1900 g, p = 0.001). However, of the 267 infants screened, 18(6.7%) had ROP while the percentage of ROP screened in 2019 was the same (44[6.7%]). During follow-up, none of medical staffs was infected and no adverse reaction was reported. Conclusions The screening for retinopathy of prematurity assisted by telemedicine network was safe and feasible during the COVID-19 pandemic. Preventive measures before and after screening were very necessary, which could effectively avoid cross infection.
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Affiliation(s)
- Zheng Guo
- Department of Ophthalmology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China
| | - Nan Ma
- Department of Ophthalmology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China
| | - Yixuan Wu
- Department of Ophthalmology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China
| | - Hua Yuan
- Department of Ophthalmology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China
| | - Wanjun Luo
- Department of infection management, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China
| | - Lingkong Zeng
- Department of neonatology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China
| | - Hong Jie
- Department of Ophthalmology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China
| | - Shilian Li
- Department of Ophthalmology, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Medical College, Huazhong University of Science & Technology, Wuhan, 430016, China.
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11
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GLYCEMIC VARIABILITY IS ASSOCIATED WITH TREATMENT REQUIRING RETINOPATHY OF PREMATURITY: A Case-Control Study. Retina 2021; 41:711-717. [PMID: 32804832 DOI: 10.1097/iae.0000000000002949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To assess the association between glycemic variability (GV) and Type 1 retinopathy of prematurity (ROP) in infants with birth weights of less than 1,251 g. METHODS A case-control study of infants with birth weights of less than 1,251 g who developed Type 1 ROP (n = 20) was conducted. Controls had a less severe ROP or no eye disease and were individually matched for gestational age and birth weight (n = 40). Odds ratios of ROP were calculated based on multiple factors including oxygen exposure, respiratory support, incidence of hyperglycemia, and GV. For glucose measurements, a continuous glucose monitoring system was used. RESULTS There were no significant differences in gender, antenatal steroid administration, severity of illness, and Apgar score. Univariate analyses suggest increased risk for the development of Type 1 ROP based on incidence of intraventricular hemorrhage Grade 3 or 4 (P = 0.048), duration of oxygen exposure (P = 0.003), incidence of hyperglycemia over 150 mg/dL (P = 0.01), and GV according to significantly higher SD (P = 0.002), coefficient of variation (P = 0.001), and mean amplitude of glucose excursion (P = 0.008). Using a multiple regression model, increased risk of Type 1 ROP was only found to be associated with duration of oxygen exposure and higher GV. CONCLUSION Our study demonstrates a relationship between GV and the development of severe ROP.
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Almeida AC, Sandinha T, Azevedo R, Brízido M, Figueiredo M, Coelho C, Teixeira S. Retrospective comparison between growth and retinopathy of prematurity model versus WINROP model. Can J Ophthalmol 2021; 57:58-64. [PMID: 33775593 DOI: 10.1016/j.jcjo.2021.02.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To compare the weight and insulin-like growth factor-1 in neonatal retinopathy (WINROP) to the growth and retinopathy of prematurity (G-ROP) model in a Portuguese cohort. DESIGN Retrospective case series. METHODS Clinical records of consecutive infants who underwent retinopathy of prematurity (ROP) screening from April 2012 to May 2019 were retrospectively reviewed. Both WINROP and G-ROP models were accessed for sensitivity and specificity for type 1 ROP. A separate analysis of both algorithms was performed in infants with gestational age (GA) <30 weeks. RESULTS Of the 375 infants included in the study, 313 were eligible for G-ROP analysis and 311 for WINROP. In the G-ROP group, 22 infants developed type 1 ROP (sensitivity 90.91%, 95% confidence interval [CI] 70.84%-98.98%). In the WINROP group, 23 infants needed treatment (sensitivity of 86.96%, 95% CI 66.41%-97.22%). Both models reached 100% sensitivity for type 1 ROP if restricted to GA <30 weeks. CONCLUSIONS Both models were easy to use and had similar sensitivities. If restricted to GA <30 weeks, both models detected all type 1 ROP.
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Affiliation(s)
- Ana C Almeida
- Department of Ophthalmology, Hospital Beatriz Angelo, Loures, Portugal; Neonatal Intensive Care Unit, Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal; CEDOC, NOVA Medical School - Universidade Nova de Lisboa, Lisbon, Portugal; Department of Ophthalmology, Hospital da Luz, Lisbon, Portugal.
| | - Teresa Sandinha
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Rita Azevedo
- Department of Ophthalmology, Hospital Beatriz Angelo, Loures, Portugal
| | - Margarida Brízido
- Department of Ophthalmology, Hospital Beatriz Angelo, Loures, Portugal
| | - Melissa Figueiredo
- Neonatal Intensive Care Unit, Hospital São Francisco Xavier - Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Constança Coelho
- Institute of Environmental Health (ISAMB), Lisbon Medical School, University of Lisbon, Lisbon, Portugal
| | - Susana Teixeira
- Department of Ophthalmology, Hospital da Luz, Lisbon, Portugal; Department of Ophthalmology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
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13
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Bai YC, Wu R, Chen SZ, Wei SY, Chen HJ, Chen YC, Feng SF, Lu XH. Efficacy of the WINROP algorithm for retinopathy of prematurity screening in Southern China. Int J Ophthalmol 2021; 14:127-132. [PMID: 33469494 PMCID: PMC7790663 DOI: 10.18240/ijo.2021.01.18] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/10/2020] [Indexed: 01/18/2023] Open
Abstract
AIM To evaluate the predicting efficacy of severe retinopathy of prematurity (ROP) by the WINROP algorithm (http://winrop.com) in Southern China. METHODS All preterm infants with the gestational age (GA) less than 32wk were included. Their ROP screening results and serial postnatal body weight were analysed retrospectively. Weekly body weight was entered into and measured by the WINROP system. The outcomes were analysed, and the sensitivity, specificity, positive predictive value and negative predictive value (NPV) were calculated. RESULTS Totally 432 infants with a median GA of 30.0 (24.0-31.9)wk, and a median birth weight (BW) of 1360 (540-2700) g were included. Among these 432 infants, 50 were diagnosed as type 1 ROP but only 28 were identified by the WINROP algorithm. The sensitivity was 56% (28/50) and the NPV was 92% (252/274). However, for infants with BW <1000 g or GA <28wk, the sensitivity was 93.8% (15/16) and 93.3% (14/15), respectively. Meanwhile, with several postnatal complications added as additional risk factors, the sensitivity was increased to 96% (48/50). CONCLUSION The sensitivity of the WINROP algorithm from the Southern Chinese cohort is not as high as that reported in developed countries. This algorithm is effective for detecting severe ROP from extremely small or preterm infants. Modification of the algorithm with additional risk factors could improve the predictive value for infants with a GA>28wk in China.
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Affiliation(s)
- Yi-Chen Bai
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Rong Wu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Si-Zhe Chen
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Shi-Yu Wei
- Department of Ophthalmology, Liuzhou People's Hospital, Liuzhou 545006, Guangxi Zhuang Autonomous Region, China
| | - Hui-Jie Chen
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Yan-Chen Chen
- Department of Pediatric, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Song-Fu Feng
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Xiao-He Lu
- Department of Ophthalmology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
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14
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Şahinoğlu Keşkek N, Gülcan H, Yılmaz G, Akkoyun İ. Impact of Platelet Count in Retinopathy of Prematurity. Turk J Ophthalmol 2020; 50:351-355. [PMID: 33389935 PMCID: PMC7802096 DOI: 10.4274/tjo.galenos.2020.01058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/11/2020] [Indexed: 12/01/2022] Open
Abstract
Objectives The aim of the study was to investigate the risk factors for retinopathy of prematurity (ROP), including platelet count. Materials and Methods This retrospective study analyzed 137 infants in 3 subgroups: no ROP; mild ROP, and severe ROP requiring laser treatment (type 1 ROP). A retrospective review of records was performed and statistical analysis of possible risk factors for ROP including platelet count was evaluated by using logistic regression. Results Birth weight (BW), gestational age (GA), and low platelet count in the first week after birth were significant risk factors for developing ROP (p=0.038, 0.02, and 0.004, respectively). BW, GA, ventilation, and lower platelet count were associated with progression to type 1 ROP (p=0.004; 0.027, and 0.021, respectively). Conclusion Lower platelet count in the first week after birth is a risk factor for ROP development in addition to the previously established factors of ventilation need, low BW, and low GA.
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Affiliation(s)
- Nedime Şahinoğlu Keşkek
- Başkent University Faculty of Medicine, Adana Research and Training Center, Department of Ophthalmology, Adana, Turkey
| | - Hande Gülcan
- Başkent University Faculty of Medicine, Adana Research and Training Center, Department of Pediatrics, Division of Neonatology, Adana, Turkey
| | - Gürsel Yılmaz
- Başkent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
| | - İmren Akkoyun
- Başkent University Faculty of Medicine, Department of Ophthalmology, Ankara, Turkey
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15
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Mehner LC, Wagner BD, Bol KA, Singh JK, Oliver SC, Patnaik JL, Palestine AG, McCourt EA, Mandava N, Wymore EM, Lynch AM. Trends in Retinopathy of Prematurity over 12 Years in a Colorado Cohort. Ophthalmic Epidemiol 2020; 28:220-226. [PMID: 32893714 DOI: 10.1080/09286586.2020.1815801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE To determine trends in retinopathy of prematurity (ROP) in a Colorado cohort between 2006 and 2017 and compare trends in risk factors between our cohort and statewide data. METHODS A retrospective cohort study was conducted by the use of records from two registry databases: 1) an academic center's ROP registry, and 2) vital statistics birth data from the Colorado Department of Public Health and Environment (CDPHE). ROP was categorized as severe (type 1 or type 2), low grade (not type 1 or type 2), or no ROP. Other variables included in the analyses were gestational age and birth weight at delivery, and infant mortality. Trends over time were evaluated for both registry databases using generalized linear models. RESULTS In our ROP registry cohort of 1,267 eligible infants, 134 (10.6%) developed severe ROP and 279 (22%) developed low-grade ROP. We found no overall trend in severe ROP rates (p = .23), and a decreasing trend in rates of low-grade ROP (p < .01) over the study period. Trends in gestational age, birth weight, and mortality rates remained stable during the study period in both the ROP registry and the CDPHE cohorts. CONCLUSION The rate of severe ROP in our ROP registry cohort did not change over time. There was evidence of a decreasing trend in low grade ROP during the 12-year study period that was not explained by a change in the primary ROP risk factors in either the ROP registry cohort or the Colorado statewide data.
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Affiliation(s)
- Lauren C Mehner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Brandie D Wagner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, CO, USA
| | - Kirk A Bol
- Colorado Department of Public Health and Environment, Registries and Vital Statistics Branch, Denver, CO, USA
| | - Jasleen K Singh
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Scott Cn Oliver
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jennifer L Patnaik
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Alan G Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Emily A McCourt
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Naresh Mandava
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Erica M Wymore
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Anne M Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, CO, USA
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Raffa LH, Alessa SK, Alamri AS, Malaikah RH. Prediction of retinopathy of prematurity using the screening algorithm WINROP in a Saudi cohort of preterm infants. Saudi Med J 2020; 41:622-627. [PMID: 32518929 PMCID: PMC7502953 DOI: 10.15537/smj.2020.6.25127] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/19/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To validate the web weight gain-based WINROP (weight, insulin-like growth factor I, neonatal, retinopathy of prematurity [ROP]) algorithm retrospectively to identify type 1 ROP in a Saudi cohort of premature infants. Methods: The records of preterm infants (greater than 23 and less than 32 weeks gestation) born between August 2013 and October 2018, were reviewed. Birth weight, gestational age, and weekly weight measurements of the premature infants were entered online. Based on weekly weight gain, the WINROP algorithm alerted clinicians whether infants were at high-risk for vision‑threatening type 1 ROP. Sensitivity, specificity, positive and negative predictive values were calculated. Results: The median gestational age of the infants at birth was 28 weeks, with median birth weight at 1085 g. Of the 175 infants included in the study, 13 (7.4%) developed type 1 ROP. WINROP positive alarm was triggered in 70.9% (124/175) of all infants and 100% (13/13) of those treated for type 1 ROP. The specificity of the algorithm was 31.5%. Positive predictive values was 10.5% and negative was 100%. Conclusion: The general WINROP sensitivity in identifying type 1 ROP was 100% similar to that reported in developed countries; however, its specificity was low at 31.5%. Tweaking of the algorithm based on the population may increase the specificity and promote the practical utility of this non-invasive screening tool for ophthalmologists and neonatologists in this population.
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Affiliation(s)
- Lina H Raffa
- Department of Ophthalmology, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. E-mail.
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17
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Wongnophirun A, Khuwuthyakorn V, Tantiprabha W, Wiwatwongwana A. Association between severe retinopathy of prematurity and postnatal weight gain in very low-birthweight infants at Chiang Mai University Hospital, Thailand. Paediatr Int Child Health 2020; 40:85-91. [PMID: 31272307 DOI: 10.1080/20469047.2019.1631588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Poor postnatal weight gain has been associated with low serum IGF-1, a key factor in the pathogenesis of retinopathy of prematurity (ROP).Aim: To investigate an association between relative weight gain (RWG) and severe ROP in very low-birthweight (VLBW) Thai infants.Methods: The medical records of VLBW infants who were admitted to the neonatal intensive care unit in Chiang Mai University Hospital from June 2014 to December 2016 and screened for ROP were reviewed. RWG and total calorie intake (TCI) in the 2nd, 4rth and 6th week of age were calculated and those with no ROP/mild ROP and severe ROP requiring laser treatment were compared.Results: The study included 139 VLBW infants, 24 (17.3%) of whom had ROP requiring laser treatment. Infants with severe ROP requiring laser treatment had a lower median birthweight (840 vs 1,195 g, p < 0.001) and median gestational age (GA) (27 vs 30 wk, p < 0.001) than those with no ROP/mild ROP. When RWG and TCI were compared, the infants with severe ROP requiring laser treatment had a lower RWG at the 2nd (p < 0.01) and 4th weeks of age (p < 0.05) and had a lower TCI at the 2nd week of age (p < 0.001) than those with no ROP/mild ROP. Multivariate logistic analysis demonstrated that GA <29.5 w (p < 0.01), hypotension (p < 0.05), RWG <2.9 g/kg/d (p < 0.05) and TCI <98.5 kcal/kg/day (p < 0.001) at the 2nd week of age were independent risk factors for severe ROP requiring laser treatment.Conclusions: Poor weight gain and low calorie intake at the 2nd week of age were associated with severe ROP requiring laser treatment in VLBW infants. Monitoring weight gain and calorie intake during this period are essential and may improve the outcome of ROP.Abbreviations: BPD, bronchopulmonary dysplasia; IVH, intraventricular haemorrhage; NEC, necrotising enterocolitis; PDA, patent ductus arteriosus; PRC, packed red cells; PVL, periventricular leucomalacia; RDS, respiratory distress syndrome; ROP, retinopathy of prematurity; RWG, relative weight gain; SGA, small for gestational age; TCI, total calorie intake; VLBW, very low birthweight.
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Affiliation(s)
- Ananya Wongnophirun
- Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Varangthip Khuwuthyakorn
- Division of Neonatology, Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Watcharee Tantiprabha
- Division of Neonatology, Department of Paediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Atchareeya Wiwatwongwana
- ROP Unit, Division of Paediatric Ophthalmology and Strabismus, Department of Ophthalmology, Chiang Mai University, Chiang Mai, Thailand
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18
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Lim ZD, Oo KT, Tai ELM, Shatriah I. Efficacy of WINROP as a Screening Tool for Retinopathy of Prematurity in the East Coast of Malaysia. Clin Ophthalmol 2020; 14:1101-1106. [PMID: 32425496 PMCID: PMC7188201 DOI: 10.2147/opth.s247820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/06/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the efficacy of the “weight, insulin-like growth factor 1, neonatal retinopathy of prematurity” (WINROP) algorithm in predicting retinopathy of prematurity (ROP) requiring treatment in Malaysia. Participants This was a retrospective study involving premature infants with gestational age less than 32 weeks treated from September 2016 to March 2019 in Hospital Universiti Sains Malaysia. Clinical diagnosis was made based on Early Treatment Retinopathy of Prematurity study. Participants’ weekly weight gain since birth was entered in the website (http://winrop.com), along with date of birth, gestational age and final clinical examination outcome. WINROP software signals an alarm if an infant is at high risk of developing ROP requiring treatment during weight data entry. By using the alarm status, the sensitivity and specificity of this algorithm for predicting ROP requiring treatment were obtained. Results Ninety-two infants were included in this study. An alarm was detected in 67 infants (72.8%). There were a total of 53 infants (54.6%) with no ROP, 15 (16.3%) of whom developed stage 1 ROP, 10 (10.8%) who developed stage 2 ROP and 14 infants (15.2%) who developed stage 3 ROP. In our study, WINROP sensitivity was 95.2% and specificity was 33.8%. Conclusion WINROP is recommended as an initial screening tool for premature infants at risk of developing treatment-requiring ROP in Malaysia. It may help to alert clinicians managing severely ill infants when clinical examinations are less possible.
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Affiliation(s)
- Zi Di Lim
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.,Ophthalmology Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Kok Tian Oo
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.,Ophthalmology Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Evelyn Li Min Tai
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.,Ophthalmology Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ismail Shatriah
- Department of Ophthalmology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia.,Ophthalmology Clinic, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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Yabas Kiziloglu O, Coskun Y, Akman I. Assessment of the G-ROP study criteria for predicting retinopathy of prematurity: results from a tertiary centre in Turkey. Int Ophthalmol 2020; 40:1647-1652. [DOI: 10.1007/s10792-020-01332-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 03/13/2020] [Indexed: 11/24/2022]
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20
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Prediction of severe retinopathy of prematurity using the weight gain, insulin-like growth factor 1, and neonatal retinopathy of prematurity algorithm in a Japanese population of preterm infants. Jpn J Ophthalmol 2020; 64:223-227. [PMID: 31900868 DOI: 10.1007/s10384-019-00709-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To retrospectively investigate the sensitivity and specificity of weight gain, insulin-like growth factor 1, and neonatal retinopathy of prematurity (WINROP) algorithm for the prediction of severe retinopathy of prematurity (ROP) in a Japanese population of preterm infants. The WINROP algorithm is a tool based on postnatal weight gain. STUDY DESIGN Retrospective cohort study. METHODS The medical records of preterm infants born between January 2011 and March 2017 were retrospectively reviewed. Infants born after 33 weeks of gestation were excluded based on the indications of the WINROP algorithm. Postnatal weight was recorded weekly on the WINROP system until postmenstrual week 36. The sensitivity and specificity of the WINROP algorithm were analyzed. RESULTS In total, 278 infants were included in this study. Based on the WINROP algorithm 110 of these infants were predicted to be at low risk for developing severe ROP and 105 did not develop severe ROP. Based on the WINROP algorithm 168 infants were predicted to be at high risk for developing severe ROP and 27 developed severe ROP. Thus, the sensitivity of the WINROP algorithm was 84.4% and the specificity 42.7%. CONCLUSION The WINROP algorithm could be used for preterm infants (gestational age of <28 weeks) without a complicated hospital course. Modification of the algorithm will improve its sensitivity and specificity for the Japanese population.
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21
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Pérez-Muñuzuri A, López-Suárez O, Mandiá-Rodríguez N, López-Sanguos C, Blanco-Teijeiro MJ, Couce ML. Validation of an IGF1 Screening Method for Retinopathy of Pre-maturity. Front Pediatr 2020; 8:615716. [PMID: 33381481 PMCID: PMC7767867 DOI: 10.3389/fped.2020.615716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
Retinopathy of pre-maturity (ROP) is a retinal disease that causes arrest of vascularization of the retina and can result in retinal detachment and blindness. Current screening protocols may not be sufficiently accurate to identify all at-risk patients. The aim of this study is to validate a method for improved identification of newborns at risk of ROP. We conducted a prospective clinical trial of pre-term newborns <32 weeks of gestation and/or <1,500 g birth weight during a 6-year period in a tertiary care hospital. We applied our new method based on measurement of insulin-like growth factor 1 (IGF1) levels at 3 weeks of age and the presence of sepsis during the first 3 weeks of life. Our screening protocol allowed exclusion of 121 (79.1%) patients for whom American Academy of Pediatrics (AAP) guidelines recommended screening, had a negative predictive value of 100%, and correctly identified all patients with ROP. Following retrospective assessment of our data based on these findings, we propose further restriction of the current AAP indications for screening to <1,100 g and <28 weeks of gestation in order to improve diagnostic efficacy while ensuring optimal use of restriction of human and material resources.
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Affiliation(s)
- Alejandro Pérez-Muñuzuri
- Neonatology Unit, University Clinical Hospital of Santiago, Santiago, Spain.,Department of Forensic Sciences, Pathology, Gynecology and Obstetrics, and Paediatrics, Health Research Institute of Santiago (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Olalla López-Suárez
- Neonatology Unit, University Clinical Hospital of Santiago, Santiago, Spain.,Department of Forensic Sciences, Pathology, Gynecology and Obstetrics, and Paediatrics, Health Research Institute of Santiago (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Natalia Mandiá-Rodríguez
- Neonatology Unit, University Clinical Hospital of Santiago, Santiago, Spain.,Department of Forensic Sciences, Pathology, Gynecology and Obstetrics, and Paediatrics, Health Research Institute of Santiago (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Carolina López-Sanguos
- Neonatology Unit, University Clinical Hospital of Santiago, Santiago, Spain.,Department of Forensic Sciences, Pathology, Gynecology and Obstetrics, and Paediatrics, Health Research Institute of Santiago (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María José Blanco-Teijeiro
- Retinal Unit, University Clinical Hospital of Santiago, Santiago, Spain.,Department of Ophthalmology, Health Research Institute of Santiago (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
| | - María Luz Couce
- Neonatology Unit, University Clinical Hospital of Santiago, Santiago, Spain.,Department of Forensic Sciences, Pathology, Gynecology and Obstetrics, and Paediatrics, Health Research Institute of Santiago (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
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Taylor S, Brown JM, Gupta K, Campbell JP, Ostmo S, Chan RVP, Dy J, Erdogmus D, Ioannidis S, Kim SJ, Kalpathy-Cramer J, Chiang MF. Monitoring Disease Progression With a Quantitative Severity Scale for Retinopathy of Prematurity Using Deep Learning. JAMA Ophthalmol 2019; 137:1022-1028. [PMID: 31268518 PMCID: PMC6613341 DOI: 10.1001/jamaophthalmol.2019.2433] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/14/2019] [Indexed: 01/08/2023]
Abstract
Importance Retinopathy of prematurity (ROP) is a leading cause of childhood blindness worldwide, but clinical diagnosis is subjective and qualitative. Objective To describe a quantitative ROP severity score derived using a deep learning algorithm designed to evaluate plus disease and to assess its utility for objectively monitoring ROP progression. Design, Setting, and Participants This retrospective cohort study included images from 5255 clinical examinations of 871 premature infants who met the ROP screening criteria of the Imaging and Informatics in ROP (i-ROP) Consortium, which comprises 9 tertiary care centers in North America, from July 1, 2011, to December 31, 2016. Data analysis was performed from July 2017 to May 2018. Exposure A deep learning algorithm was used to assign a continuous ROP vascular severity score from 1 (most normal) to 9 (most severe) at each examination based on a single posterior photograph compared with a reference standard diagnosis (RSD) simplified into 4 categories: no ROP, mild ROP, type 2 ROP or pre-plus disease, or type 1 ROP. Disease course was assessed longitudinally across multiple examinations for all patients. Main Outcomes and Measures Mean ROP vascular severity score progression over time compared with the RSD. Results A total of 5255 clinical examinations from 871 infants (mean [SD] gestational age, 27.0 [2.0] weeks; 493 [56.6%] male; mean [SD] birth weight, 949 [271] g) were analyzed. The median severity scores for each category were as follows: 1.1 (interquartile range [IQR], 1.0-1.5) (no ROP), 1.5 (IQR, 1.1-3.4) (mild ROP), 4.6 (IQR, 2.4-5.3) (type 2 and pre-plus), and 7.5 (IQR, 5.0-8.7) (treatment-requiring ROP) (P < .001). When the long-term differences in the median severity scores across time between the eyes progressing to treatment and those who did not eventually require treatment were compared, the median score was higher in the treatment group by 0.06 at 30 to 32 weeks, 0.75 at 32 to 34 weeks, 3.56 at 34 to 36 weeks, 3.71 at 36 to 38 weeks, and 3.24 at 38 to 40 weeks postmenstrual age (P < .001 for all comparisons). Conclusions and Relevance The findings suggest that the proposed ROP vascular severity score is associated with category of disease at a given point in time and clinical progression of ROP in premature infants. Automated image analysis may be used to quantify clinical disease progression and identify infants at high risk for eventually developing treatment-requiring ROP. This finding has implications for quality and delivery of ROP care and for future approaches to disease classification.
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Affiliation(s)
- Stanford Taylor
- Department of Ophthalmology, Casey Eye institute, Oregon Health & Science University, Portland
| | - James M. Brown
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown
| | - Kishan Gupta
- Department of Ophthalmology, Casey Eye institute, Oregon Health & Science University, Portland
| | - J. Peter Campbell
- Department of Ophthalmology, Casey Eye institute, Oregon Health & Science University, Portland
| | - Susan Ostmo
- Department of Ophthalmology, Casey Eye institute, Oregon Health & Science University, Portland
| | - R. V. Paul Chan
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago
| | - Jennifer Dy
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Deniz Erdogmus
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Stratis Ioannidis
- Department of Electrical and Computer Engineering, Northeastern University, Boston, Massachusetts
| | - Sang J. Kim
- Department of Ophthalmology, Casey Eye institute, Oregon Health & Science University, Portland
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jayashree Kalpathy-Cramer
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown
- Massachusetts General Hospital and Brigham and Women’s Hospital Center for Clinical Data Science, Boston
| | - Michael F. Chiang
- Department of Ophthalmology, Casey Eye institute, Oregon Health & Science University, Portland
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland
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Wirth M, Naud A, Caputo G, Hascoët JM. Algorithm for predicting threshold retinopathy of prematurity is insufficient and fundus examinations are still needed before 31 weeks. Acta Paediatr 2019; 108:1049-1054. [PMID: 30461053 DOI: 10.1111/apa.14654] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/11/2018] [Accepted: 11/16/2018] [Indexed: 12/31/2022]
Abstract
AIM We evaluated the weight, insulin-like growth factor-1, neonatal, retinopathy of prematurity (WINROP) algorithm for very premature infants. METHOD Infants born before 32 weeks who had undergone fundus examinations in the neonatal intensive care unit at the University Hospital of Nancy were included in this French retrospective cohort study from July 2012 to July 2016. We evaluated how well the WINROP software predicted threshold retinopathy of prematurity (ROP). RESULTS We studied 570 infants with a mean gestational age of 28.7 ± 1.8 weeks and a mean birth weight of 1110 ± 297 g: 28.1% had ROP and 1.2% had threshold ROP. The overall WINROP sensitivity was 57.1%, specificity was 46.0%, predictive positive value was 1.3% and predictive negative value was 98.9%. At more than 30 weeks of gestation or 1250 g, these figures rose to a respective specificity of 100% and 95.7% and respective predictive negative value of 100% and 100%. There were independent associations between the severity of ROP and the Apgar score at five minutes, the duration of oxygen therapy and non-invasive ventilation. CONCLUSION WINROP worked better on preterm infants born from 31 weeks onwards or weighing over 1250 g. Fundus examinations remain necessary for infants born earlier or lighter.
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Affiliation(s)
- M Wirth
- Department of Neonatology University Hospital of Nancy Nancy France
- EA3450 ‐ DevAH University of Lorraine Vandoeuvre les Nancy France
| | - A Naud
- Department of Neonatology University Hospital of Nancy Nancy France
| | - G Caputo
- Department of Paediatric Ophthalmology Adolphe de Rothschild Ophthalmological Foundation Paris France
| | - J M Hascoët
- Department of Neonatology University Hospital of Nancy Nancy France
- EA3450 ‐ DevAH University of Lorraine Vandoeuvre les Nancy France
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Berrington JE, Clarke P, Embleton ND, Ewer AK, Geethanath R, Gupta S, Lal M, Oddie S, Shafiq A, Vasudevan C, Bührer C. Retinopathy of prematurity screening at ≥30 weeks: urinary NTpro-BNP performance. Acta Paediatr 2018; 107:1722-1725. [PMID: 29617052 DOI: 10.1111/apa.14354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 11/29/2022]
Abstract
AIM Urinary N-terminal B-type natriuretic peptide NTproBNP levels are associated with the development of retinopathy of prematurity (ROP) in infants <30 weeks of gestation. The incidence of ROP in more mature infants who meet other ROP screening criteria is very low. We therefore aimed to test whether urinary NTproBNP predicted ROP development in these infants. METHODS Prospective observational study in 151 UK infants ≥30 + 0 weeks of gestation but also <32 weeks of gestation and/or <1501 g, to test the hypothesis that urinary NTproBNP levels on day of life (DOL) 14 and 28 were able to predict ROP development. RESULTS Urinary NTproBNP concentrations on day 14 and day 28 of life did not differ between infants with and without ROP (medians 144 vs 128 mcg/mL, respectively, p = 0.86 on DOL 14 and medians 117 vs 94 mcg/mL, respectively, p = 0.64 on DOL28). CONCLUSION The association previously shown for infants <30 completed weeks between urinary NTproBNP and the development of ROP was not seen in more mature infants. Urinary NTproBNP does not appear helpful in rationalising direct ophthalmoscopic screening for ROP in more mature infants, and may suggest a difference in pathophysiology of ROP in this population.
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Affiliation(s)
- JE Berrington
- Newcastle Neonatal Service; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
- Institute of Cellular Medicine; Newcastle University; Newcastle upon Tyne UK
| | - P Clarke
- Norfolk and Norwich University Hospitals NHS Foundation Trust; Norfolk UK
| | - ND Embleton
- Newcastle Neonatal Service; Newcastle upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
- Institute of Health and Society; Newcastle University; Newcastle upon Tyne UK
| | - AK Ewer
- Birmingham Womens Hospital; Birmingham UK
| | | | - S Gupta
- University Hospital of North Tees; Stockton UK
| | - M Lal
- South Tees NHS Foundation Trust; Middlesbrough UK
| | - S Oddie
- Bradford Teaching Hospitals NHS Foundation Trust; Bradford UK
| | - A Shafiq
- Department of Ophthalmology; Newcastle Upon Tyne Hospitals NHS Foundation Trust; Newcastle upon Tyne UK
| | - C Vasudevan
- Bradford Teaching Hospitals NHS Foundation Trust; Bradford UK
| | - C Bührer
- Charité Universitätsmedizin; Berlin Germany
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McCourt EA, Ying GS, Lynch AM, Palestine AG, Wagner BD, Wymore E, Tomlinson LA, Binenbaum G. Validation of the Colorado Retinopathy of Prematurity Screening Model. JAMA Ophthalmol 2018; 136:409-416. [PMID: 29543944 PMCID: PMC5876910 DOI: 10.1001/jamaophthalmol.2018.0376] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/23/2018] [Indexed: 11/14/2022]
Abstract
Importance The Colorado Retinopathy of Prematurity (CO-ROP) model uses birth weight, gestational age, and weight gain at the first month of life (WG-28) to predict risk of severe retinopathy of prematurity (ROP). In previous validation studies, the model performed very well, predicting virtually all cases of severe ROP and potentially reducing the number of infants who need ROP examinations, warranting validation in a larger, more diverse population. Objective To validate the performance of the CO-ROP model in a large multicenter cohort. Design, Setting, Participants This study is a secondary analysis of data from the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study, a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada between January 2006 and June 2012 of 6351 premature infants who received ROP examinations. Main Outcomes and Measures Sensitivity and specificity for severe (early treatment of ROP [ETROP] type 1 or 2) ROP, and reduction in infants receiving examinations. The CO-ROP model was applied to the infants in the G-ROP data set with all 3 data points (infants would have received examinations if they met all 3 criteria: birth weight, <1501 g; gestational age, <30 weeks; and WG-28, <650 g). Infants missing WG-28 information were included in a secondary analysis in which WG-28 was considered fewer than 650 g. Results Of 7438 infants in the G-ROP study, 3575 (48.1%) were girls, and maternal race/ethnicity was 2310 (31.1%) African American, 3615 (48.6%) white, 233 (3.1%) Asian, 40 (0.52%) American Indian/Alaskan Native, and 93 (1.3%) Pacific Islander. In the study cohort, 747 infants (11.8%) had type 1 or 2 ROP, 2068 (32.6%) had lower-grade ROP, and 3536 (55.6%) had no ROP. The CO-ROP model had a sensitivity of 96.9% (95% CI, 95.4%-97.9%) and a specificity of 40.9% (95% CI, 39.3%-42.5%). It missed 23 (3.1%) infants who developed severe ROP. The CO-ROP model would have reduced the number of infants who received examinations by 26.1% (95% CI, 25.0%-27.2%). Conclusions and Relevance The CO-ROP model demonstrated high but not 100% sensitivity for severe ROP and missed infants who might require treatment in this large validation cohort. The model requires all 3 criteria to be met to signal a need for examinations, but some infants with a birth weight or gestational age above the thresholds developed severe ROP. Most of these infants who were not detected by the CO-ROP model had obvious deviation in expected weight trajectories or nonphysiologic weight gain. These findings suggest that the CO-ROP model needs to be revised before considering implementation into clinical practice.
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Affiliation(s)
- Emily A. McCourt
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Gui-Shuang Ying
- Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Anne M. Lynch
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Alan G. Palestine
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Brandie D. Wagner
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Erica Wymore
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora
| | - Lauren A. Tomlinson
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gil Binenbaum
- Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Division of Ophthalmology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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26
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N-terminal B-type natriuretic peptide urinary concentrations and retinopathy of prematurity. Pediatr Res 2017; 82:958-963. [PMID: 28738027 DOI: 10.1038/pr.2017.179] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 06/26/2017] [Indexed: 11/08/2022]
Abstract
BackgroundTo validate the findings of a single-center pilot study showing elevated urinary N-terminal B-type natriuretic peptide (NTproBNP) concentrations in preterm infants subsequently developing severe retinopathy of prematurity (ROP) in a multicenter setting across eight European and Middle East countries.MethodsProspective observational study in 967 preterm infants <30 weeks' gestational age assessing the capacity of urinary NTproBNP on days of life (DOLs) 14 and 28 to predict ROP requiring treatment.ResultsUrinary NTproBNP concentrations were markedly elevated in infants who developed ROP requiring treatment (n=94) compared with survivors without ROP treatment (n=837), at both time points (median (interquartile range) DOL14: 8,950 (1,925-23,783) vs. 3,083 (1,193-17,393) vs. 816 (290-3,078) pg/ml, P<0.001) and DOL28 (2,203 (611-4,063) vs. 1,671 (254-11,340) vs. 408 (162-1,126) pg/ml, P<0.001). C-statistic of NTproBNP for treated ROP or death was 0.731 (95% confidence interval 0.654-0.774) for DOL14 and 0.683 (0.622-0.745) for DOL28 (P<0.001). Threshold scores were calculated, potentially enabling around 20% of infants with low NTproBNP scores never to be screened with ophthalmoscopy.ConclusionThere is a strong association between early urinary NTproBNP and subsequent ROP development, which can be used to further refine subgroups of patients with high or low risk of severe ROP.
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