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PEDIATRICS Vol. 102 No. 1 July 1998, pp. 31-34
Received Jun 9, 1997; accepted Dec 16, 1997.
, and
From the * Department of Pediatrics, University of Tennessee
Graduate School of Medicine; and Department of Statistics,
University of Tennessee, Knoxville, Tennessee.
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 
32 weeks or birth weights 1500 g. All cases of threshold and Stage 4 ROP were confined to infants with gestational ages 
30 weeks or birth weights <1200 g.
Conclusions. The latest American Academy of Pediatrics
screening guidelines for ROP are discretionary for infants with birth weights >1500 g or gestational ages >28 weeks. If ROP screening is
limited to infants with birth weights of 1500 g, 34.2% fewer infants
would require screening compared with the previous <1800 g
recommendation, while missing no cases of ROP more than Stage 1. A
gestational age cut-off of 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 <32 weeks, the number of patients
requiring screening could be reduced 29.1% compared with the previous
recommendation of <35 weeks, again without missing any cases of ROP
more than Stage 1. Use of such a screening strategy (birth weight
<1500 g or gestational age <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.
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