Predictors for the Development of Referral-Warranted Retinopathy of Prematurity in the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP) Study

Abstract

for the e-ROP Cooperative Group IMPORTANCE Detection of treatment-requiring retinopathy of prematurity (ROP) involves serial eye examinations. An ROP prediction model using predictive factors could identify high-risk infants and reduce required eye examinations.OBJECTIVE To determine predictive factors for the development of referral-warranted (RW) ROP. DESIGN, SETTING, AND PARTICIPANTSThis multicenter observational cohort study included secondary analysis of data from the Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity Study. Infants included in the study had a birth weight (BW) of less than 1251 g. EXPOSURES Serial ROP examinations of premature infants who had 2 or more ROP examinations. MAIN OUTCOMES AND MEASURESIncidence of RW-ROP (defined as the presence of plus disease, zone I ROP, or ROP stage 3 or greater in either eye) and associations with predictive factors.RESULTS Among 979 infants without RW-ROP at first study-related eye examination (median postmenstrual age, 33 weeks; range, 29-40 weeks) who underwent at least 2 eye examinations, 149 (15.2%) developed RW-ROP. In a multivariate model, significant predictors for RW-ROP were male sex (odds ratio [OR], 1.80; 95% CI, 1.13-2.86 vs female), nonblack race (OR, 2.76; 95% CI, 1.50-5.08 for white vs black race and OR, 4.81; 95% CI, 2.19-10.6 for other vs black race), low BW (OR, 5.16; 95% CI, 1.12-7.20 for Յ500 g vs >1100 g), younger gestational age (OR, 9.79; 95% CI, 3.49-27.5 for Յ24 weeks vs Ն28 weeks), number of quadrants with preplus disease (OR, 7.12; 95% CI, 2.53-20.1 for 1-2 quadrants and OR, 18.4; 95% CI, 4.28-79.4 for 3-4 quadrants vs no preplus disease), stage 2 ROP (OR, 4.13; 95% CI, 2.13-8.00 vs no ROP), the presence of retinal hemorrhage (OR, 4.36; 95% CI, 1.57-12.1 vs absence), the need for respiratory support (OR, 4.99; 95% CI, 1.89-13.2 for the need for controlled mechanical ventilator; OR, 11.0; 95% CI, 2.26-53.8 for the need for high-frequency oscillatory ventilation vs no respiratory support), and slow weight gain (OR, 2.44; 95% CI, 1.22-4.89 for weight gain Յ12 g/d vs >18 g/d). These characteristics predicted the development of RW-ROP significantly better than BW and gestational age (area under receiver operating characteristic curve, 0.88 vs 0.78; P < .001). CONCLUSIONS AND RELEVANCEWhen controlling for very low BW and prematurity, the presence of preplus disease, stage 2 ROP, retinal hemorrhage, and the need for ventilation at time of first study-related eye examination were strong independent predictors for RW-ROP. These predictors may help identify infants in need of timely eye examinations.

Risk Score for Predicting Treatment-Requiring Retinopathy of Prematurity (ROP) in the Telemedicine Approaches to Evaluating Acute-Phase ROP Study

“…13;17–24 These models varied as they use different predictors for different severity of ROP (RW-ROP, severe ROP, treatment requiring ROP, etc.). In contrast to previous ROP prediction models/algorithms, our prediction model and resulting risk score is unique in that we used the findings of trained readers’ evaluation of images taken at the first image session (34 PMA weeks or earlier) for predicting the future development of TR-ROP.…”

“…Our previous investigation showed that ROP morphological findings of an eye at the first eye exam performed by an ophthalmologist predicted the subsequent development of referral-warrant ROP (RW-ROP), beyond what is already predicted by the BW, GA, postnatal weight gain, and respiratory support status at exam. 13 Since ROP telemedicine is based on evaluation of retinal images, identifying earlier image characteristics for developing a risk score that predicts the subsequent development of TR-ROP (TR-ROP) will enhance its functionality and clinical utility. Such risk score could lead to improved ROP telemedicine screening and reduce the burden of diagnostic eye examinations by ROP specialists for detecting TR-ROP.…”

Advances in understanding and management of retinopathy of prematurity

“…(6) eROP also determined predictors for development of referral warranted ROP after controlling for gestational age and very low birth weight as pre-Plus, retinal hemorrhage, Stage 2 or mechanical ventilation at first examination. (202)…”

“…(192, 202)Once a diagnosis of “referral-warranted” ROP is made, however, resources and protocols for transport and treatment of infants must be in place.…”

A Tiered Approach to Retinopathy of Prematurity Screening (TARP) Using a Weight Gain Predictive Model and a Telemedicine System

“…20,21 Multiple predictive models using weight gain, BW, and GA have been developed, 11,26 including the following: weight, insulinlike growth factor, and neonatal ROP (WINROP) 14,15 ; The Children’s Hospital of Philadelphia ROP (CHOP-ROP) 13 ; ROPScore 18 ; Colorado–retinopathy of prematurity model (CO-ROP) 19 ; and Telemedicine Approaches to Evaluating Acute-Phase Retinopathy of Prematurity (e-ROP). 16 These models have high sensitivity for predicting severe ROP (97%–100% in some populations), while potentially reducing the number of infants requiring examinations by 25% to 75%. 13,14,19 The CHOP-ROP model is a logistic regression–based equation that had 100% (95% CI, 84%–100%) sensitivity for predicting type 1 ROP among 524 infants meeting current screening criteria and would have reduced the number of infants receiving examinations by 49%in its retrospective development cohort.…”