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ROP screening in the NICU

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 <30 weeks gestation at birth or < 1500g birthweight should be screened for ROP. Selected infants >30 week with an unstable clinical course (i.e. NEC, IVH sepsis) may also be screened by attending request.

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 31 – 36 weeks PMA

Gestational Age	Weeks PMA	Chronologic Age
22 weeks	31 weeks	9 weeks
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	4 weeks
28 weeks	34 weeks	4 weeks
29 weeks	33 weeks	4 weeks
30 weeks	34 weeks	4 weeks
31 weeks (at attending's request)	35 weeks	4 weeks
32 weeks (at attending's request)	36 weeks	4 weeks

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A Log Book is maintained for eye exams. The case managers help the residents assure that appropriate infants are scheduled for eye exams.

The ophthalmologist performing screening exams for the month will notify the case manager in advance of the anticipated dates and times of screening, as well as any necessary orders.

A parent education brochure should be made available for the family prior to the exam.

On the day preceding the ophthalmologist’s visit, the case managers will stamp up consult sheets. There is a standing order set in WIZ for Eye Exam per Protocol. In preparation for the initial eye exam information regarding patient history (birth weight, gestational age, CGA) is completed by the Case Manager. All prior exams should be readily available at the infants bedside for review. The bedside nurses dilate the infant’s eye per protocol of screening.

On or before the day of eye exams, the ophthalmologist calls or sends an email to notify the case manager that the infants’ eyes should be dilated, and the Case Manager notifies the bedside nurses.

Cyclomydril 1 gtt in each eye and repeat every 5 minutes X3. The bedside nurse is also responsible for restraining the infant during the exam. 24% sucrose water/pacifier should be given 2 minutes prior to actual exam and may be repeated x 1 during exam as needed.

Lighting should be kept low for 4 hours after exam, as eyes will be sensitive to light due to pupil dilatation.

After the exam is completed, the ophthalmologist will leave one copy of the completed consult sheets at the infant’s bedside. The ophthalmologist returns a copy of the consult sheet to the Eye Institute to be scanned into the patient’s EMR. The results should be noted by the residents and reported on rounds. The ophthalmologist places the exam list with recommended follow-up in the Eye log book. The case manger will note and record dates for follow-up exams if indicated.

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.