Research Article: Optimizing retinopathy of prematurity screening in China using a single objective criterion: a 10-year retrospective analysis
Abstract:
To evaluate the efficacy of a single objective screening criterion—birth weight (BW)?<?2000g or gestational age (GA)?<?32 weeks—for retinopathy of prematurity (ROP) detection, and to provide evidence for reducing over-screening caused by subjective clinical judgment.
This retrospective study enrolled 1,453 premature infants who underwent ROP screening at Sichuan Provincial People's Hospital (2014–2024). Fundus examinations were performed using binocular indirect ophthalmoscopy or RetCam III. A two-tier grouping strategy was adopted: objective criterion group (BW?<?2000g or GA?<?32 weeks) vs. subjective group (BW???2000g and GA???32 weeks). The objective group was further subdivided into three subgroups. ROP and severe ROP were diagnosed following Chinese Guidelines for the Screening of Retinopathy of Prematurity (2014) , with severe ROP defined as type 1 ROP requiring clinical treatment. The study population was stratified into inborn infants and referred infants for sensitivity analysis. Multivariable logistic regression identified independent risk factors for severe ROP.
Among 1,453 infants (618 inborn, 836 referred), 705 ROP cases (48.5%) and 370 severe ROP cases (25.5%) were identified. The objective group covered 98.2% of ROP cases and 99.2% of severe ROP cases. ROP and severe ROP prevalence were significantly higher in the objective group than in the subjective group (both P <?0.001). Multivariable regression identified lower GA (OR?=?1.42 per week decrease) and lower BW (OR?=?1.21 per 100?g decrease) as independent risk factors for severe ROP (both P <?0.001); sex, case source, and birth year were not significant. All three severe ROP cases in the subjective group were diagnosed in or before 2017, with no new cases reported after 2017.
The single objective criterion of BW?<?2000g or GA?<?32 weeks can effectively identify the high-risk population for ROP. Subjective extended screening has minimal clinical value in tertiary neonatal care institutions; it is recommended that the subjective high-risk clause may be cautiously omitted in clinical practice within tertiary hospitals with advanced neonatal care capabilities.
Introduction:
Retinopathy of prematurity (ROP) remains a leading cause of preventable childhood blindness, which underscores the urgent need for efficient and accurate screening strategies. The current Chinese Guidelines for the Screening of Retinopathy of Prematurity (2014) ( 1 ) adopt a dual-entry screening model: (1) objective criteria (BW?<?2000g or GA?<?32 weeks); and (2) subjective criteria (infants with severe systemic conditions or a documented history of prolonged oxygen exposure, deemed as high-risk by…
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