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Postnatal weight gain algorithm may help predict ROP risk
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Postnatal weight gain may be a valid parameter to stratify infants at risk for developing retinopathy of prematurity, according to a study. More specifically, a weight gain of at least 23 g/day can be considered as a protective cut-off value against development of ROP.
Current ROP screening guidelines are based on a prediction model consisting of birth weight and gestational age treated dichotomously. Infants with a birth weight of less than 1,501 g or with a gestational age of 30 weeks or less are subject to physically stressful and resource-intensive ROP examinations. This results in high sensitivity because almost all severe ROP cases are detected but low specificity because a large number of examined infants do not develop severe ROP.
According to a multivariate regression analysis based on medical records from two tertiary referral centers, the implementation of postnatal weight gain rate can increase sensitivity up to 62%, without incurring the risk of failing to diagnose severe ROP cases.
Of the 191 infants meeting the inclusion criteria and examined in the study, 17 developed type 1 ROP requiring intravitreal injection or laser photocoagulation and 174 developed type 2 ROP, mild ROP or no ROP requiring no further treatment.
Infants in the treatment group had lower mean birth weight (647 g) as compared with the non-treatment group (1,298 g). Weight gain per day was calculated for both the treatment and the non-treatment groups, and a weight gain cut-off rate of 23 g/day was determined as a protective factor against the development of type 1 ROP. Weight gain based on these parameters showed a high predictive value for treatment, maintaining 100% sensitivity but increasing specificity to 62%.
According to the authors, these findings may help develop a practical model to identify at-risk infants. A simple growth rate calculator could be incorporated into the electronic medical record.
“The reduced number of infants requiring examinations and the associated burden of coordinating ROP examinations would likely be decreased by the use of this risk stratification process,” they wrote.
However, due to the limited sample size of the study, they recommended that this screening algorithm should only be used as an adjunct to current ROP screening guidelines.
“We stress that the stratification model represented in our study should be considered preliminary and is not intended for clinical use at this time,” they wrote. – by Michela Cimberle
Disclosures: The authors report no relevant financial disclosures.
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