Practice Guideline Briefs

AAP Revised Recommendations for Examination of Infants for ROP

Am Fam Physician. 2006 Jun 1;73(11):2077.

The American Academy of Pediatrics (AAP) has released a policy statement revising its 2001 statement on screening examination of premature infants for retinopathy of prematurity (ROP). The revised policy statement was published in the February 2006 issue of Pediatrics and is available at http://pediatrics.aappublications.org/cgi/content/full/117/2/572.

The statement focuses on the elements that help establish an efficient program for detecting and treating ROP. Because ROP is sequential and timely treatment has been proven to reduce the risk of vision loss, it is imperative that at-risk infants receive carefully timed retinal examinations and that all physicians who care for at-risk preterm infants should be aware of the importance of timing. Therefore, the AAP made the following recommendations:

  • A retinal screening examination should be performed after pupillary dilation using binocular indirect ophthalmoscopy on all infants with a birth weight of less than 3 lb, 5 oz (1,500 g) or a gestational age of 32 weeks or less. Examination also should be performed on selected infants with a birth weight of 3 lb, 5 oz to 4 lb, 6 oz (1,500 to 2,000 g) or a gestational age of more than 32 weeks with an unstable clinical course.

  • Knowledgeable and experienced ophthalmologists should perform retinal examinations on preterm infants and classify, diagram, and record findings using the standards from the International Committee for the Classification of Retinopathy of Prematurity.

  • The initiation of acute-phase ROP screening should be based on the infant's age because the onset of serious ROP correlates more with postmenstrual age (i.e., gestational age at birth plus chronologic age) rather than postnatal age. Thus, the youngest infants at birth take the longest time to develop serious ROP.

  • The ophthalmologist should recommend follow-up examination based on retinal findings categorized by the international classification.

  • Physicians who are involved in ophthalmologic care of preterm infants should be aware that the findings calling for consideration of ablative treatment were recently revised using results from the Early Treatment for Retinopathy of Prematurity Randomized Trial Study.

  • Acute retinal screening examination conclusions should be based on ophthalmoscopic findings and infant age.

  • Parent and staff communication about ROP is important, and documentation of these conversations is recommended.

  • Each newborn intensive care unit should define responsibility for examination of at-risk infants. Each unit should have specific criteria based on birth weight and gestational age, and the criteria should be established through discussion and agreement between the neonatal and ophthalmology departments.


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