Development of modified screening criteria for retinopathy of prematurity primary results from the postnatal growth and retinopathy of prematurity study

G-ROP Study Group

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

IMPORTANCE Current retinopathy of prematurity (ROP) guidelines, which are based on studies of high-risk infants and expert opinion, have low specificity for disease requiring treatment. Postnatal weight gain-based models improve specificity but have been limited by complexity and small development cohorts, which results in model overfitting and resultant decreased sensitivity in validation studies. OBJECTIVE To develop a birth weight (BW), gestational age (GA), and weight gain (WG) prediction model using data from a broad-risk cohort of premature infants. DESIGN, SETTING, AND PARTICIPANTS The Postnatal Growth and ROP Studywas a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada from 2006 to 2012 that included 7483 premature infants at risk for ROP with a known ROP outcome. A hybrid modeling approach was used that combined BW/GA criteria, weight comparison with expected growth from infants without ROP, multiple growth-interval assessments, consideration of nonphysiological WG, and user-friendly screening criteria. Numerous BW/GA levels, postnatal age periods, time intervals, andWG percentile thresholds were evaluated to identify the most robust parameters. MAIN OUTCOME AND MEASURES Sensitivity for Early Treatment of ROP Study type 1 ROP and potential reduction in infants who require examinations. RESULTS Of 7483 infants, the median (SD) BW was 1099 (359) g, the median GA was 28 weeks (range, 22-35), 3575 (47.8%) were female, 3615 (48.4%) were white, 2310 (30.9%) were black, 233 (3.1%) were Asian, 93 (1.2%) were Pacific Islander, and 40 (0.5%) were American Indian/Alaskan Native. Infants who met any of 6 criteria would undergo examinations: (1) a GA of younger than 28 weeks; (2) a BWof less than 1051 g; aWG of less than 120 g, 180 g, or 170 g during ages 10 to 19, 20 to 29, or 30 to 39 days, respectively; or hydrocephalus. These criteria predicted 459 of 459 (100%) type 1 (sensitivity, 100%; 95%CI, 99.2%-100%), 524 of 524 (100%) treated, and 466 of 472 (98.7%) type 2 cases while reducing the number of infants who required examinations by 2269 (30.3%). CONCLUSIONS AND RELEVANCE This cohort study, broadly representative of infants who are undergoing ROP examinations, provides evidence-based screening criteria. With validation, the Postnatal Growth and ROP Study criteria could be incorporated into ROP screening guidelines to reduce the number of infants who require examinations in North America.

Original languageEnglish (US)
Pages (from-to)1034-1040
Number of pages7
JournalJAMA Ophthalmology
Volume136
Issue number9
DOIs
StatePublished - Sep 1 2018

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Retinopathy of Prematurity
Growth
Gestational Age
Birth Weight
Weight Gain
Premature Infants
Cohort Studies
Guidelines
North American Indians
Validation Studies
Expert Testimony
Hydrocephalus
North America
Multicenter Studies
Canada
Weights and Measures

ASJC Scopus subject areas

  • Ophthalmology

Cite this

Development of modified screening criteria for retinopathy of prematurity primary results from the postnatal growth and retinopathy of prematurity study. / G-ROP Study Group.

In: JAMA Ophthalmology, Vol. 136, No. 9, 01.09.2018, p. 1034-1040.

Research output: Contribution to journalArticle

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title = "Development of modified screening criteria for retinopathy of prematurity primary results from the postnatal growth and retinopathy of prematurity study",
abstract = "IMPORTANCE Current retinopathy of prematurity (ROP) guidelines, which are based on studies of high-risk infants and expert opinion, have low specificity for disease requiring treatment. Postnatal weight gain-based models improve specificity but have been limited by complexity and small development cohorts, which results in model overfitting and resultant decreased sensitivity in validation studies. OBJECTIVE To develop a birth weight (BW), gestational age (GA), and weight gain (WG) prediction model using data from a broad-risk cohort of premature infants. DESIGN, SETTING, AND PARTICIPANTS The Postnatal Growth and ROP Studywas a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada from 2006 to 2012 that included 7483 premature infants at risk for ROP with a known ROP outcome. A hybrid modeling approach was used that combined BW/GA criteria, weight comparison with expected growth from infants without ROP, multiple growth-interval assessments, consideration of nonphysiological WG, and user-friendly screening criteria. Numerous BW/GA levels, postnatal age periods, time intervals, andWG percentile thresholds were evaluated to identify the most robust parameters. MAIN OUTCOME AND MEASURES Sensitivity for Early Treatment of ROP Study type 1 ROP and potential reduction in infants who require examinations. RESULTS Of 7483 infants, the median (SD) BW was 1099 (359) g, the median GA was 28 weeks (range, 22-35), 3575 (47.8{\%}) were female, 3615 (48.4{\%}) were white, 2310 (30.9{\%}) were black, 233 (3.1{\%}) were Asian, 93 (1.2{\%}) were Pacific Islander, and 40 (0.5{\%}) were American Indian/Alaskan Native. Infants who met any of 6 criteria would undergo examinations: (1) a GA of younger than 28 weeks; (2) a BWof less than 1051 g; aWG of less than 120 g, 180 g, or 170 g during ages 10 to 19, 20 to 29, or 30 to 39 days, respectively; or hydrocephalus. These criteria predicted 459 of 459 (100{\%}) type 1 (sensitivity, 100{\%}; 95{\%}CI, 99.2{\%}-100{\%}), 524 of 524 (100{\%}) treated, and 466 of 472 (98.7{\%}) type 2 cases while reducing the number of infants who required examinations by 2269 (30.3{\%}). CONCLUSIONS AND RELEVANCE This cohort study, broadly representative of infants who are undergoing ROP examinations, provides evidence-based screening criteria. With validation, the Postnatal Growth and ROP Study criteria could be incorporated into ROP screening guidelines to reduce the number of infants who require examinations in North America.",
author = "{G-ROP Study Group} and Gil Binenbaum and Bell, {Edward F.} and Pamela Donohue and Graham Quinn and James Shaffer and Tomlinson, {Lauren A.} and Ying, {Gui Shuang} and Pamela Donoh and Anh Nguyen and Duros, {Trang B.} and Maguire, {Maureen G.} and Mary Brightwell-Arnold and Maria Blanco and Trina Brown and Helker, {Christopher P.} and Barry, {Gerard P.} and Marilyn Fisher and Battaglia, {Maria V.} and Drach, {Alex M.} and Repka, {Michael X.} and Megan Doherty and Shepard, {Jennifer A.} and Reynolds, {James D.} and Erin Connelly and Edward Cheeseman and Carol Bradham and Allison McAlpine and Sudeep Sunthankar and Kinsey Shirer and Javaneh Abbasian and Janet Lim and Michael Yang and Alfano, {Elizabeth L.} and Patricia Cobb and David Rogers and Fellows, {Rae R.} and Kaitlyn Loh and McGregor, {Madeline A.} and Thabit Mustafa and Reem, {Rachel E.} and Tess Russell and Rebecca Stattler and Sara Oravec and David Young and Andrea Siu and Michele Kanemori and Jingyun Wang and Kathryn Haider and Elizabeth Hynes and Dumitrescu, {Alina V.}",
year = "2018",
month = "9",
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doi = "10.1001/jamaophthalmol.2018.2753",
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TY - JOUR

T1 - Development of modified screening criteria for retinopathy of prematurity primary results from the postnatal growth and retinopathy of prematurity study

AU - G-ROP Study Group

AU - Binenbaum, Gil

AU - Bell, Edward F.

AU - Donohue, Pamela

AU - Quinn, Graham

AU - Shaffer, James

AU - Tomlinson, Lauren A.

AU - Ying, Gui Shuang

AU - Donoh, Pamela

AU - Nguyen, Anh

AU - Duros, Trang B.

AU - Maguire, Maureen G.

AU - Brightwell-Arnold, Mary

AU - Blanco, Maria

AU - Brown, Trina

AU - Helker, Christopher P.

AU - Barry, Gerard P.

AU - Fisher, Marilyn

AU - Battaglia, Maria V.

AU - Drach, Alex M.

AU - Repka, Michael X.

AU - Doherty, Megan

AU - Shepard, Jennifer A.

AU - Reynolds, James D.

AU - Connelly, Erin

AU - Cheeseman, Edward

AU - Bradham, Carol

AU - McAlpine, Allison

AU - Sunthankar, Sudeep

AU - Shirer, Kinsey

AU - Abbasian, Javaneh

AU - Lim, Janet

AU - Yang, Michael

AU - Alfano, Elizabeth L.

AU - Cobb, Patricia

AU - Rogers, David

AU - Fellows, Rae R.

AU - Loh, Kaitlyn

AU - McGregor, Madeline A.

AU - Mustafa, Thabit

AU - Reem, Rachel E.

AU - Russell, Tess

AU - Stattler, Rebecca

AU - Oravec, Sara

AU - Young, David

AU - Siu, Andrea

AU - Kanemori, Michele

AU - Wang, Jingyun

AU - Haider, Kathryn

AU - Hynes, Elizabeth

AU - Dumitrescu, Alina V.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - IMPORTANCE Current retinopathy of prematurity (ROP) guidelines, which are based on studies of high-risk infants and expert opinion, have low specificity for disease requiring treatment. Postnatal weight gain-based models improve specificity but have been limited by complexity and small development cohorts, which results in model overfitting and resultant decreased sensitivity in validation studies. OBJECTIVE To develop a birth weight (BW), gestational age (GA), and weight gain (WG) prediction model using data from a broad-risk cohort of premature infants. DESIGN, SETTING, AND PARTICIPANTS The Postnatal Growth and ROP Studywas a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada from 2006 to 2012 that included 7483 premature infants at risk for ROP with a known ROP outcome. A hybrid modeling approach was used that combined BW/GA criteria, weight comparison with expected growth from infants without ROP, multiple growth-interval assessments, consideration of nonphysiological WG, and user-friendly screening criteria. Numerous BW/GA levels, postnatal age periods, time intervals, andWG percentile thresholds were evaluated to identify the most robust parameters. MAIN OUTCOME AND MEASURES Sensitivity for Early Treatment of ROP Study type 1 ROP and potential reduction in infants who require examinations. RESULTS Of 7483 infants, the median (SD) BW was 1099 (359) g, the median GA was 28 weeks (range, 22-35), 3575 (47.8%) were female, 3615 (48.4%) were white, 2310 (30.9%) were black, 233 (3.1%) were Asian, 93 (1.2%) were Pacific Islander, and 40 (0.5%) were American Indian/Alaskan Native. Infants who met any of 6 criteria would undergo examinations: (1) a GA of younger than 28 weeks; (2) a BWof less than 1051 g; aWG of less than 120 g, 180 g, or 170 g during ages 10 to 19, 20 to 29, or 30 to 39 days, respectively; or hydrocephalus. These criteria predicted 459 of 459 (100%) type 1 (sensitivity, 100%; 95%CI, 99.2%-100%), 524 of 524 (100%) treated, and 466 of 472 (98.7%) type 2 cases while reducing the number of infants who required examinations by 2269 (30.3%). CONCLUSIONS AND RELEVANCE This cohort study, broadly representative of infants who are undergoing ROP examinations, provides evidence-based screening criteria. With validation, the Postnatal Growth and ROP Study criteria could be incorporated into ROP screening guidelines to reduce the number of infants who require examinations in North America.

AB - IMPORTANCE Current retinopathy of prematurity (ROP) guidelines, which are based on studies of high-risk infants and expert opinion, have low specificity for disease requiring treatment. Postnatal weight gain-based models improve specificity but have been limited by complexity and small development cohorts, which results in model overfitting and resultant decreased sensitivity in validation studies. OBJECTIVE To develop a birth weight (BW), gestational age (GA), and weight gain (WG) prediction model using data from a broad-risk cohort of premature infants. DESIGN, SETTING, AND PARTICIPANTS The Postnatal Growth and ROP Studywas a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada from 2006 to 2012 that included 7483 premature infants at risk for ROP with a known ROP outcome. A hybrid modeling approach was used that combined BW/GA criteria, weight comparison with expected growth from infants without ROP, multiple growth-interval assessments, consideration of nonphysiological WG, and user-friendly screening criteria. Numerous BW/GA levels, postnatal age periods, time intervals, andWG percentile thresholds were evaluated to identify the most robust parameters. MAIN OUTCOME AND MEASURES Sensitivity for Early Treatment of ROP Study type 1 ROP and potential reduction in infants who require examinations. RESULTS Of 7483 infants, the median (SD) BW was 1099 (359) g, the median GA was 28 weeks (range, 22-35), 3575 (47.8%) were female, 3615 (48.4%) were white, 2310 (30.9%) were black, 233 (3.1%) were Asian, 93 (1.2%) were Pacific Islander, and 40 (0.5%) were American Indian/Alaskan Native. Infants who met any of 6 criteria would undergo examinations: (1) a GA of younger than 28 weeks; (2) a BWof less than 1051 g; aWG of less than 120 g, 180 g, or 170 g during ages 10 to 19, 20 to 29, or 30 to 39 days, respectively; or hydrocephalus. These criteria predicted 459 of 459 (100%) type 1 (sensitivity, 100%; 95%CI, 99.2%-100%), 524 of 524 (100%) treated, and 466 of 472 (98.7%) type 2 cases while reducing the number of infants who required examinations by 2269 (30.3%). CONCLUSIONS AND RELEVANCE This cohort study, broadly representative of infants who are undergoing ROP examinations, provides evidence-based screening criteria. With validation, the Postnatal Growth and ROP Study criteria could be incorporated into ROP screening guidelines to reduce the number of infants who require examinations in North America.

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