Validation of DIGIROP models and decision support tool for prediction of treatment for retinopathy of prematurity on a contemporary Swedish cohort

Pivodic, Aldina; Smith, Lois E H; Hård, Anna‐Lena; Löfqvist, Chatarina; Almeida, Ana C.; Al-Hawasi, Abbas; Larsson, Eva; Lundgren, Pia; Sunnqvist, Birgitta; Törnqvist, Kristina; Wallin, Agneta; Holmström, Gerd; Gränse, Lotta

doi:10.1136/bjophthalmol-2021-320738

Cited by 5 publications

(6 citation statements)

References 35 publications

(21 reference statements)

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“…50 The new algorithm seems to have a good potential, as it has been validated both internally and externally and its accuracy is comparable to that of previous prediction models. 51 Due to geographical variations in socio-economic development, screening inclusion criteria vary by region, as there are no unanimous guidelines for ROP. 52 At the last update, the American Academy of Ophthalmology (AAO) recommended the inclusion in the screening of all premature babies with a gestational age <30 weeks or a birth weight <1500 grams.…”

Section: Future Directions On Rop Screeningmentioning

confidence: 99%

Latest Trends in Retinopathy of Prematurity: Research on Risk Factors, Diagnostic Methods and Therapies

Bezman¹,

Tiutiuca²,

Totolici³

et al. 2023

IJGM

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Retinopathy of prematurity (ROP) is a vasoproliferative disorder with an imminent risk of blindness, in cases where early diagnosis and treatment are not performed. The doctors' constant motivation to give these fragile beings a chance at life with optimal visual acuity has never stopped, since Terry first described this condition. Thus, throughout time, several specific advancements have been made in the management of ROP. Apart from the most known risk factors, this narrative review brings to light the latest research about new potential risk factors, such as: proteinuria, insulin-like growth factor 1 (IGF-1) and blood transfusions. Digital imaging has revolutionized the management of retinal pathologies, and it is more and more used in identifying and staging ROP, particularly in the disadvantaged regions by the means of telescreening. Moreover, optical coherence tomography (OCT) and automated diagnostic tools based on deep learning offer new perspectives on the ROP diagnosis. The new therapeutical trend based on the use of anti-VEGF agents is increasingly used in the treatment of ROP patients, and recent research sustains the theory according to which these agents do not interfere with the neurodevelopment of premature babies.

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Section: Future Directions On Rop Screeningmentioning

confidence: 99%

Latest Trends in Retinopathy of Prematurity: Research on Risk Factors, Diagnostic Methods and Therapies

Bezman¹,

Tiutiuca²,

Totolici³

et al. 2023

IJGM

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“…The DIGIROP birth model showed specificity of approximately 50% and the DIGIROP screen model up to approximately 80% during screening. In a contemporary Swedish cohort, approximately 50% specificity at birth was maintained, but 4 infants with severe comorbidities of 57 with ROP treatment were identified as not needing ROP screening . Inclusion of a clinical variable representing infants’ comorbidity was warranted.…”

Section: Introductionmentioning

confidence: 99%

“…The Postnatal Growth and ROP (G-ROP) model, developed on approximately 7500 infants from the US and Canada, includes GA, BW, hydrocephalus, and weight gain for days 10 to 19, 20 to 29, and 30 to 39. 13,14 Further, we developed and validated 2 prediction models for ROP treatment based on approximately 7000 Swedish infants born at 24 to 30 weeks' GA. [15][16][17][18][19] The Digital ROP (DIGIROP) birth model includes GA, sex, and standardized BW. Additionally, the timing for the first ROP diagnosis is included in DIGIROP screen model.…”

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confidence: 99%

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Prognostic Value of Parenteral Nutrition Duration on Risk of Retinopathy of Prematurity

et al. 2023

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ImportanceThe prognostic impact of parenteral nutrition duration (PND) on retinopathy of prematurity (ROP) is not well studied. Safe prediction models can help optimize ROP screening by effectively discriminating high-risk from low-risk infants.ObjectiveTo evaluate the prognostic value of PND on ROP; to update and validate the Digital ROP (DIGIROP) 2.0 birth into prescreen and screen prediction models to include all ROP-screened infants regardless of gestational age (GA) and incorporate PND; and to compare the DIGIROP model with the Weight, IGF-1, Neonatal, and ROP (WINROP) and Postnatal Growth and ROP (G-ROP) models.Design, Setting, and ParticipantsThis retrospective study included 11 139 prematurely born infants from 2007 to 2020 from the Swedish National Registry for ROP. Extended Poisson and logistic models were applied. Data were analyzed from August 2022 to February 2023.Main Outcomes and MeasuresAny ROP and ROP requiring treatment were studied in relation to PND. ROP treatment was the outcome in DIGIROP models. Sensitivity, specificity, area under the receiver operating characteristic curve, and adjusted OR (aOR) with 95% CI were the main measures. Internal and external validations were performed.ResultsOf 11 139 screened infants, 5071 (45.5%) were girls, and the mean (SD) gestational age was 28.5 (2.4) weeks. ROP developed in 3179 infants (29%), treatment was given in 599 (5%), 7228 (65%) had PND less than 14 days, 2308 (21%) had PND for 14 days or more, and 1603 (14%) had unknown PND. PND was significantly correlated with ROP severity (Spearman r = 0.45; P &lt; .001). Infants with 14 days or more of PND vs less than 14 days had faster progression from any ROP to ROP treatment (adjusted mean difference, −0.9 weeks; 95% CI, −1.5 to −0.3; P = .004). Infants with PND for 14 days or more vs less than 14 days had higher odds of any ROP (aOR, 1.84; 95% CI, 1.62-2.10; P &lt; .001) and of severe ROP requiring treatment (aOR, 2.20; 95% CI, 1.73-2.80; P &lt; .001). Among all 11 139 infants, the DIGIROP 2.0 models had 100% sensitivity (95% CI, 99.4-100). The specificity was 46.6% (95% CI, 45.6-47.5) for the prescreen model and 76.9% (95% CI, 76.1-77.7) for the screen model. G-ROP as well as the DIGIROP 2.0 prescreen and screen models showed 100% sensitivity on a validation subset (G-ROP: sensitivity, 100%; 95% CI, 93-100; DIGIROP prescreen: sensitivity, 100%; 95% CI, 93-100; DIGIROP screen: sensitivity, 100%; 95% CI, 93-100), whereas WINROP showed 89% sensitivity (95% CI, 77-96). Specificity for each prediction model was 29% (95% CI, 22-36) for G-ROP, 38% (95% CI, 32-46) for DIGIROP prescreen, 53% (95% CI, 46-60) for DIGIROP screen at 10 weeks, and 46% (95% CI, 39-53) for WINROP.Conclusion and RelevanceBased on more than 11 000 ROP-screened infants born in Sweden, PND of 14 days or more corresponded to a significantly higher risk of having any ROP and receiving ROP treatment. These findings provide evidence to support consideration of using the updated DIGIROP 2.0 models instead of the WINROP or G-ROP models in the management of ROP.

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“…Later, WINROP was found to function well using only weight gain, omitting IGF-1 blood sampling ( Hellstrom et al, 2009 ). As even accurate weight gain may be difficult to measure routinely in preterm infants, recently, DIGIROP using GA at birth, sex, standardized birth weight and age at the first sign of ROP was developed to predict the risk for severe ROP and shows high predicative ability in a contemporary Swedish cohort without using either IGF-1 or weight gain ( Pivodic et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Retinopathy of prematurity: Metabolic risk factors

Nilsson

Hellström

et al. 2022

eLife

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At preterm birth, the retina is incompletely vascularized. Retinopathy of prematurity (ROP) is initiated by the postnatal suppression of physiological retinal vascular development that would normally occur in utero. As the neural retina slowly matures, increasing metabolic demand including in the peripheral avascular retina, leads to signals for compensatory but pathological neovascularization. Currently, only late neovascular ROP is treated. ROP could be prevented by promoting normal vascular growth. Early perinatal metabolic dysregulation is a strong but understudied risk factor for ROP and other long-term sequelae of preterm birth. We will discuss the metabolic and oxygen needs of retina, current treatments, and potential interventions to promote normal vessel growth including control of postnatal hyperglycemia, dyslipidemia and hyperoxia-induced retinal metabolic alterations. Early supplementation of missing nutrients and growth factors and control of supplemental oxygen promotes physiological retinal development. We will discuss the current knowledge gap in retinal metabolism after preterm birth.

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Validation of DIGIROP models and decision support tool for prediction of treatment for retinopathy of prematurity on a contemporary Swedish cohort

Cited by 5 publications

References 35 publications

Latest Trends in Retinopathy of Prematurity: Research on Risk Factors, Diagnostic Methods and Therapies

Latest Trends in Retinopathy of Prematurity: Research on Risk Factors, Diagnostic Methods and Therapies

Prognostic Value of Parenteral Nutrition Duration on Risk of Retinopathy of Prematurity

Retinopathy of prematurity: Metabolic risk factors

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