Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
Scheie Eye Institute, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
JAMA Ophthalmol. 2018 Sep 1;136(9):1034-1040. doi: 10.1001/jamaophthalmol.2018.2753.
Current retinopathy of prematurity (ROP) guidelines, which are based on studies of high-risk infants and expert opinion, have low specificity for disease requiring treatment. Postnatal weight gain-based models improve specificity but have been limited by complexity and small development cohorts, which results in model overfitting and resultant decreased sensitivity in validation studies.
To develop a birth weight (BW), gestational age (GA), and weight gain (WG) prediction model using data from a broad-risk cohort of premature infants.
DESIGN, SETTING, AND PARTICIPANTS: The Postnatal Growth and ROP Study was a retrospective multicenter cohort study conducted in 29 hospitals in the United States and Canada from 2006 to 2012 that included 7483 premature infants at risk for ROP with a known ROP outcome. A hybrid modeling approach was used that combined BW/GA criteria, weight comparison with expected growth from infants without ROP, multiple growth-interval assessments, consideration of nonphysiological WG, and user-friendly screening criteria. Numerous BW/GA levels, postnatal age periods, time intervals, and WG percentile thresholds were evaluated to identify the most robust parameters.
Sensitivity for Early Treatment of ROP Study type 1 ROP and potential reduction in infants who require examinations.
Of 7483 infants, the median (SD) BW was 1099 (359) g, the median GA was 28 weeks (range, 22-35), 3575 (47.8%) were female, 3615 (48.4%) were white, 2310 (30.9%) were black, 233 (3.1%) were Asian, 93 (1.2%) were Pacific Islander, and 40 (0.5%) were American Indian/Alaskan Native. Infants who met any of 6 criteria would undergo examinations: (1) a GA of younger than 28 weeks; (2) a BW of less than 1051 g; a WG of less than 120 g, 180 g, or 170 g during ages 10 to 19, 20 to 29, or 30 to 39 days, respectively; or hydrocephalus. These criteria predicted 459 of 459 (100%) type 1 (sensitivity, 100%; 95% CI, 99.2%-100%), 524 of 524 (100%) treated, and 466 of 472 (98.7%) type 2 cases while reducing the number of infants who required examinations by 2269 (30.3%).
This cohort study, broadly representative of infants who are undergoing ROP examinations, provides evidence-based screening criteria. With validation, the Postnatal Growth and ROP Study criteria could be incorporated into ROP screening guidelines to reduce the number of infants who require examinations in North America.
目前的早产儿视网膜病变（ROP）指南是基于高危婴儿的研究和专家意见制定的，对需要治疗的疾病特异性较低。基于出生后体重增加的模型可以提高特异性，但受到复杂性和小的发展队列的限制，这导致模型过度拟合，并且在验证研究中敏感性降低。
利用来自广泛风险早产儿队列的数据，开发一种基于出生体重（BW）、胎龄（GA）和体重增加（WG）的预测模型。
设计、地点和参与者：《产后生长与 ROP 研究》是一项在美国和加拿大 29 家医院进行的回顾性多中心队列研究，于 2006 年至 2012 年进行，共纳入 7483 名有 ROP 风险的早产儿，其中 459 名（6.1%）为 ROP 1 期，524 名（7.0%）接受了治疗。使用混合建模方法，该方法结合了 BW/GA 标准、与无 ROP 婴儿的预期生长比较、多个生长间隔评估、非生理性 WG 的考虑以及用户友好的筛选标准。评估了许多 BW/GA 水平、出生后年龄期、时间间隔和 WG 百分位数阈值，以确定最稳健的参数。
ROP 早期治疗研究（ETDRS）1 型 ROP 的敏感性和潜在减少需要检查的婴儿数量。
在 7483 名婴儿中，中位数（SD）BW 为 1099（359）g，中位数 GA 为 28 周（范围，22-35），3575 名（47.8%）为女性，3615 名（48.4%）为白人，2310 名（30.9%）为黑人，233 名（3.1%）为亚洲人，93 名（1.2%）为太平洋岛民，40 名（0.5%）为美洲印第安人/阿拉斯加原住民。符合以下任何 6 项标准的婴儿将接受检查：（1）GA 小于 28 周；（2）BW 小于 1051 g；（3）WG 在 10 至 19、20 至 29 或 30 至 39 天期间小于 120、180 或 170 g；或脑积水。这些标准预测了 459 例（100%）1 型（敏感性 100%；95%CI，99.2%-100%）、524 例（100%）治疗和 466 例（98.7%）2 型病例，同时减少了 2269 例（30.3%）需要检查的婴儿数量。
这项队列研究广泛代表了正在接受 ROP 检查的婴儿，提供了基于证据的筛查标准。经过验证，Postnatal Growth and ROP 研究标准可以纳入 ROP 筛查指南，以减少北美需要检查的婴儿数量。
