Risk and clinical course of retinopathy of prematurity in 78 infants of gestational age 22-25 weeks

PurposeTo characterize the retinopathy of prematurity (ROP) and survival of infants born at gestational age (GA) of 22-25 weeks.MethodsThis study was a comparative case series for the total set of 78 infants ≤25 GA screened for ROP at a level IV NICU during a 21-month period. Data are presented on infants screened for ROP from 6 weeks after birth for 22 and 23 weeks' GA infants and from 5 weeks after birth for 24 and 25 weeks' GA. Accounting for the competing risk of mortality, we implemented Cox CR regression models to assess birth weight, GA, and admission diagnosis as potential risk factors for the following time to event outcomes: type 1 disease, aggressive posterior ROP (AP-ROP), plus disease, first presentation of ROP, and worst ROP observed.ResultsRisk of laser treatment (subhazard ratio [SHR] = 0.56, P = 0.007) and of plus disease (SHR = 0.49, P = 0.001) was increased among those born at lower GA. Twenty infants required laser for type 1 disease at median postmenstrual age (PMA) of 35.8 weeks (range, 33.0-42.7); infants with AP-ROP had laser at PMA of 34.5 weeks (range, 33.0-36.9), 2 weeks earlier than infants without AP-ROP at PMA 36.5 weeks (range, 33.9-42.7). The cumulative probability of receiving laser therapy approached 46% (22 or 23 weeks' GA), 30% (24 weeks' GA), and 18% (25 weeks' GA).ConclusionsThe 2013 screening guidelines appear to be appropriate for infants of 22 and 23 weeks' GA when ROP screening begins at PMA 31 weeks.