Importance of Early Postnatal Weight Gain for Normal Retinal Angiogenesis in Very Preterm Infants

Abstract

Objective To assess WINROP (https://winrop.com), an algorithm using postnatal weight measurements, as a tool for the prediction of retinopathy of prematurity (ROP) in a large geographically and racially diverse study population. Methods WINROP analysis was performed retrospectively on conventionally at-risk infants from 10 neonatal intensive care units.Weight measurements were entered into WINROP, which signals an alarm for an abnormal weight gain rate.Infants were classified into categories of no alarm (unlikely to develop type 1 ROP) and alarm (at risk for developing type 1ROP).Use of WINROP requires that an infant has(1)gestational age less than 32 weeks at birth, (2) weekly weight measurements,(3)physiologic weight gain,and(4)absence of other pathologic retinal vascular disease. Results A total of 1706 infants with a median gestational age of 28 weeks (range, 22-31 weeks) and median birth weight of 1016 g (range, 378-2240 g) were included in the study analysis. An alarm occurred in 1101 infants (64.5%), with a median time from birth to alarm of 3 weeks (range, 0-12 weeks) and from alarm to treatment of 8 weeks (range, 1 day to 22 weeks). The sensitivity of WINROP was 98.6% and the negative predictive value was 99.7%. Two infants with type 1 ROP requiring treatment after 40 weeks’ postmenstrual age did not receive an alarm. Conclusion The WINROP system is a useful adjunct for ROP screening that identifies high-risk infants early to optimize care and potentially reduce the overall number of diagnostic ROP examinations.

Implementing higher oxygen saturation targets reduced the impact of poor weight gain as a predictor for retinopathy of prematurity

“…Accordingly, we found that WINROP was no longer useful for predicting ROP in the later study period. The development of WINROP was originally based on a cohort of very preterm infants at the Queen Silvia Children's Hospital 10 and previously validated in Sweden and other populations in settings with highly developed neonatal care with a sensitivity of 96–100% 7, 8, 15. WINROP only identified half of the infants that needed treatment in the 2015–2016 cohort and this was comparable to outcomes observed in settings with less developed neonatal care and poor oxygen control 9.…”

“…A web‐based prediction tool–weight, insulin‐like growth factor 1, neonatal, retinopathy of prematurity (WINROP) – based on weight development, predicts ROP needing treatment with high sensitivity in settings with highly developed neonatal care 7, 8, but with lower sensitivity in settings with poor oxygen control 9.…”

The Specificity of the WINROP Algorithm Can Be Significantly Increased by Reassessment of the WINROP Alarm

“…In this study, the following two cohorts previously assessed by WINROP were utilized: (1) the population-based Extremely Preterm Infants in Sweden Study (EXPRESS) cohort comprising 407 infants born at GA <27 weeks in Sweden during 2004-2007 [17] and (2) a North American cohort comprising 1,706 infants born at GA 22-31 weeks in the USA and Canada during 2006-2009 [14]. In these previous studies the infants were conventionally screened for ROP, according to present screening guidelines.…”

“…WINROP has been evaluated in different preterm populations, both in Sweden and worldwide [12,13,14,15,16,17]. Adjustments to the WINROP algorithm have been suggested for specific populations in order to improve its sensitivity and specificity [18].…”

Oxygen Monitoring Reduces the Risk for Retinopathy of Prematurity in a Mexican Population

“…WINROP was originally developed in a Swedish preterm population and has been validated in another Swedish population with 100% sensitivity and 84.5% specificity [9,12]. In other countries, the sensitivity and specificity of WINROP have been slightly reduced [13,14,15,16,17]. WINROP was previously validated in infants screened for ROP in 2005-2010 at the neonatal intensive care unit (NICU) at the Hospital Civil de Guadalajara, Mexico [16].…”