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Published online March 16, 2009
PEDIATRICS Vol. 123 No. 4 April 2009, pp. e638-e645 (doi:10.1542/peds.2008-2697)
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ARTICLE

Early Weight Gain Predicts Retinopathy in Preterm Infants: New, Simple, Efficient Approach to Screening

Ann Hellström, MD, PhDa, Anna-Lena Hård, MD, PhDa, Eva Engström, MD, PhDb, Aimon Niklasson, MD, PhDb, Eva Andersson, PhDc,d, Lois Smith, MD, PhDe, Chatarina Löfqvist, PhDa

a Department of Pediatric Ophthalmology, Institute of Neuroscience and Physiology
b Department of Pediatrics, Institute of Clinical Sciences
c Statistical Research Unit
d Department of Occupational and Environmental Medicine, The Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
e Department of Ophthalmology, Children's Hospital, Harvard Medical School, Boston, Massachusetts

BACKGROUND. The risk for sight-threatening retinopathy of prematurity is predicted by using gestational age and/or weight at birth. All infants below a threshold undergo serial ophthalmologic examinations for identification of those who would benefit from treatment (~10%). We hypothesized that factoring in postnatal weight gain could identify children at risk for sight-threatening retinopathy of prematurity more specifically and earlier.

METHODS. Weekly weights from birth to postmenstrual week 36 were retrospectively entered into a surveillance system that gave an alarm when the rate of weight gain decreased to a certain level. For all children (N = 354) screened and/or treated for retinopathy of prematurity at Sahlgrenska University Hospital in 2004–2007, weekly weights were recorded. One child was excluded because of known nonphysiologic weight gain (hydrocephalus).

RESULTS. For 127 (36%) of 353 children, no alarm was given; for 40%, alarm at low risk was given after postmenstrual week 32. None of those children developed retinopathy of prematurity requiring treatment. Of the remaining 24% of children who received alarm at high or low risk before 32 postmenstrual weeks, 41% developed proliferative retinopathy of prematurity and 29% were treated because of sight-threatening disease. The median time from alarm to treatment was 9 weeks.

CONCLUSIONS. The weight, insulin-like growth factor, neonatal retinopathy of prematurity algorithm detected early 100% of infants who developed retinopathy of prematurity requiring treatment and correctly predicted the majority who did not require treatment. With this simple postnatal evaluation, costly stressful eye examinations can be markedly reduced (~75% of infants). In addition, early identification of children at risk may lead to the initiation of interventions and possibly prevent sight-threatening retinopathy of prematurity.

Key Words: retinopathy of prematurity • screening • weight gain

Abbreviations: ROP—retinopathy of prematurity • WINROP—weight, insulin-like growth factor, neonatal retinopathy of prematurity • ETROP—Early Treatment for Retinopathy of Prematurity • IGF—insulin-like growth factor • GA—gestational age • PMA—postmenstrual age • CI—confidence interval

Accepted Dec 17, 2008.


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[Abstract] [Full Text] [PDF]

eLetters:

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Weight gain and retinopathy of prematurity (ROP)
Joao B Fortes Filho, et al.
Pediatrics Online, 1 Apr 2009 [Full text]
Predicting ROP with weight gain should be further validated
Bai-Horng Su, et al.
Pediatrics Online, 20 Dec 2009 [Full text]
Using weight gain among premature babies to determine the risk of ROP may be premature
Clare Gilbert, et al.
Pediatrics Online, 25 Jan 2010 [Full text]