ROP screening in the NICU

(Version 1.0  11/14/2001 - 6/18/2006)

Retinopathy of prematurity (ROP) is a proliferative vascular retinopathy which afflicts the smallest, sickest, and most premature neonates in the NICU, blinding 400 infants each year in the US. Screening ophthalmologic exams are designed to detect severe ROP before it progresses to complete retinal detachment. Peripheral retinal ablation by laser photocoagulation is applied when a baby’s eyes reach a predefined threshold level of disease; this treatment is often vision-saving.

All infants <28 weeks gestation at birth or < 1500g birthweight should be screened for ROP.

Infants < 35 weeks gestation at birth who have been extremely ill and unstable may also be screened by attending request. (The literature suggests that the "extremely unstable" clause really only needs to apply to <32 weeks infants.) Attendings may also excuse infants who are >32 weeks gestation but SGA and <1500g from ROP screening if they have been quite stable as these infants are very low risk.

Infants should be screened at or before 32 – 34 weeks PMA, but not before 5 weeks chronologic age.

Gestational Age

Weeks PMA

 Chronologic Age
23 weeks 31 weeks 8 weeks
24 weeks 31 weeks 7 weeks
25 weeks 32 weeks 7 weeks
26 weeks 32 weeks 6 weeks
27 weeks 33 weeks 6 weeks
28 weeks 34 weeks 6 weeks

The Medical Receptionist maintains a Log Book for eye exams. The case managers help the residents assure that appropriate infants are scheduled for eye exams.

On the day preceding the ophthalmologist’s visit, the medical receptionist will stamp up consult sheets and a physician order sheet and write "Eye Exam per Protocol." The attending or fellow signs these sheets. On the day of eye exams, the ophthalmologist calls to notify the medical receptionist that the infants’ eyes should be dilated, and the medical receptionist notifies the bedside nurses.

The bedside nurses dilate the infant’s eye per protocol:

Cyclomydril 1 gtt OU and repeat in 5 – 10 minutes. The bedside nurse is also responsible for restraining the infant during the exam.

After the exam is completed, the ophthalmologist will leave the completed consult sheets at the infant’s bedside. The results should be noted by the residents and reported on rounds. The medical receptionist will note and record dates for follow-up exams if indicated.

This information is also available in the 2001 NICU Manual pg. 8-14.

References:

American Academy of Pediatrics. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2001; 108: 809-811.

Wright, K, et al. Should fewer premature infants be screened for retinopathy of prematurity in the managed care era? Pediatrics 1998; 102: 31-34.

Subhani, M, et al. Screening guidelines for retinopathy of prematurity: the need for revision in extremely low birth weight infats. Pediatrics 2001; 107: 656-659.

Phelps, D. The STOP-ROP Multicenter Trial: Current Status. Presented at Hot Topics in Neonatology, Washington DC, 1999.

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