Retinopathy of prematurity: Recommendations for screening

A joint guideline of the Fetus and Newborn Committee, Canadian Paediatric Society (CPS), and the Canadian Association of Paediatric Ophthalmologists

Paediatr Child Health 1998;3(3):197
Reference No. FN98-01

Revision in progress February 2009

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Retinopathy of prematurity (ROP) is a disorder that can cause blindness in premature infants. It is now known that many infants with this disorder who are treated with ablative therapy in a timely fashion will avoid this serious outcome. It is essential that those caring for premature infants know who is at risk of retinopathy of prematurity, when screening must begin and how often these infants need to be examined. It is also important to know when to treat those infants who develop severe retinopathy of prematurity and what long term follow-up is needed to manage other complications of retinopathy of prematurity. Table 1 provides answers to these questions. The background data upon which these recommendations are based are found in the accompanying article, Paediatrics and Child Health 1998;3(3):173-80.

The recommendations are based on currently available information. Further research is needed in the following areas: systematic reviews of new therapies (eg, surfactant) and their impact on ROP; prevention of ROP; randomized trials of the currently available surgical treatment for ROP; and a Canadian surveillance system for ROP.

TABLE 1: Summary of recommendations for screening the Canadian population

Risk group

· Infants 30 weeks gestational age or younger or

· Infants 1500 g or less birth weight

Who examines the eyes

· Observer skilled in the recognition of retinopathy of prematurity, usually an ophthalmologist

Schedule of assessments

· First examination at four to six weeks postnatal age

· Two to four weeks after the first examination if retinopathy of prematurity does not exist

· More frequent examinationss as determined by the ophthalmologist if retinopathy of prematurity does exist on any examination

Long term follow-up

· Within six to 12 months corrected gestational age

· At age four years

FETUS AND NEWBORN COMMITTEE

Members: Drs Daniel Faucher, Royal Victoria Hospital, Montreal, Quebec; Douglas McMillan (chair), Foothills Hospital, Calgary, Alberta; Arne Ohlsson, Women’s College Hospital, Toronto, Ontario; Michael Vincer (principal author), IWK Grace Health Centre, Halifax, Nova Scotia; Robin Walker, Children’s Hospital of Eastern Ontario, Ottawa, Ontario; John Watts (director responsible), Children’s Hospital at Hamilton Health Sciences Corporation, Hamilton, Ontario
Liaisons: Ms Debbie Askin, St Boniface Hospital, Winnipeg, Manitoba (Neonatal Nursing); Drs Cheryl Levitt, McMaster University Medical Centre, Hamilton Health Sciences Corporation, Hamilton, Ontario (College of Family Physicians); William Oh, Rhode Island Hospital, Providence, Rhode Island (Committee on Fetus and Newborn, American Academy of Pediatrics); James Lemons, Riley Hospital for Children, Indianapolis, Indiana (Committee on Fetus and Newborn, American Academy of Pediatrics); Robert Liston, IWK Grace Health Centre, Halifax, Nova Scotia (Maternal-Fetal Medicine Committee, Society of Obstetricians and Gynaecologists of Canada); Catherine McCourt, Laboratory Centre for Disease Control, Health Canada, Ottawa, Ontario (Health Canada); Reg Sauve (Section of Neonatal Perinatal Medicine, Canadian Paediatric Society), Alberta Children’s Hospital, Calgary, Alberta
Principal author: Dr Michael Vincer, IWK Grace Health Centre, Halifax, Nova Scotia
Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication.