With modern neonatal intensive care, retinopathy of prematurity (ROP) has become almost exclusively a disease of the smallest, sickest, and most premature infants. The highest risk period for progressive ROP often occurs after the infant has stabilized and is more mature (31 – 40 weeks postconceptual age.) The infant may even be ready for discharge or back transport when vision-threatening ROP occurs.

To ensure appropriate ophthalmologic screening of the highest risk babies, all infants < 1000g birth weight must have their first ROP screening eye exam before they leave the NICU (BT or DC) and follow-up must be arranged.

Infants with or at risk for ROP cannot be back-transported to institutions that cannot perform appropriate follow-up eye exams as an inpatient unless the patient is close enough to discharge that the family will be able to return to VUMC as an outpatient on time for the infant’s ROP exam.

Marlee Crankshaw and Katy Prince have been working on a fact sheet for parents and pediatricians stressing the importance of ophthalmologic follow-up for high-risk infants. Before discharge, parents will be asked to sign a form stating that they understand the importance of ophthalmologic exams; they will be given a date for their follow-up exam at discharge, and this date must be available to the local pediatrician in the discharge summary.

Discussed at the Collaborative Pathways Committee meetings 1/10/01 and 4/25/01.