Should fewer premature infants be screened for retinopathy of prematurity in the managed care era?

Setting a reasonable cutoff level for screening premature infants for retinopathy of prematurity (ROP) could save more than $1.5 million a year without missing any cases of ROP beyond Stage I. In examining 707 infants, no ROP beyond Stage I was found in infants gestated 32 weeks or more or with birth weights of 1500 grams or more. This amounted to 34.2% fewer screenings needed. Using a lower cutoff of 28 weeks would miss some infants with more advanced retinopathy.
Objective. To determine appropriate upper limits for gestational age and birth weight when screening infants for retinopathy of prematurity (ROP). Design. Retrospective survey. Setting. Tertiary neonatal intensive care nursery. Patients. Seven hundred seven infants born July 1, 1990 to June 30, 1996 and screened for ROP according to the 1988 to 1996 American Academy of Pediatrics guidelines. Outcome Measures. Maximum stage of ROP with respect to birth weight and gestational age. Results. No ROP more than Stage 1 was observed in infants with gestational ages [is greater than or equal to] 32 weeks or birth weights 1500 g. All cases of threshold and Stage 4 ROP were confined to infants with gestational ages [is less than or equal to] 30 weeks or birth weights [is less than] 1200 g. Conclusions. The latest American Academy of Pediatrics screening guidelines for ROP are discretionary for infants with birth weights [is greater than] 1500 g or gestational ages [is greater than] 28 weeks. If ROP screening is limited to infants with birth weights of [is less than or equal to] 1500 g, 34.2% fewer infants would require screening compared with the previous [is less than] 1800 g recommendation, while missing no cases of ROP more than Stage 1. A gestational age cut-off of [is less than or equal to] 28 weeks, however, is less desirable, and could potentially miss several infants with more advanced retinopathy (including Stage 4). If ROP screening criteria were instead modified to include infants of gestational ages [is less than] 32 weeks, the number of patients requiring screening could be reduced 29.1% compared with the previous recommendation of [is less than] 35 weeks, again without missing any cases of ROP more than Stage 1. Use of such a screening strategy (birth weight [is less than] 1500 g or gestational age [is less than] 32 weeks) is predicted to save in excess of 1.5 million dollars annually in the United States, while missing no cases of ROP more than Stage 1. Pediatrics 1998;102:31-34; retinopathy of prematurity. ABBREVIATIONS. AAP, American Academy of Pediatrics; ROP, retinopathy of prematurity; CI, confidence interval.
The American Academy of Pediatrics (AAP), the American Association for Pediatric Ophthalmology and Strabismus, and the American Academy of Ophthalmology together have recently recommended new screening guidelines for the timely [...]