Elsevier

The Journal of Pediatrics

Volume 161, Issue 5, November 2012, Pages 819-823
The Journal of Pediatrics

Original Article
Factors Associated with Failure to Screen Newborns for Retinopathy of Prematurity

https://doi.org/10.1016/j.jpeds.2012.04.020Get rights and content

Objectives

To evaluate ROP screening rates in a population-based cohort; and to identify characteristics of patients that were missed.

Study design

We used the California Perinatal Quality Care Collaborative data from 2005-2007 for a cross-sectional study. Using eligibility criteria, screening rates were calculated for each hospital. Multivariable regression was used to assess associations between patient clinical and sociodemographic factors and the odds of missing screening.

Results

Overall rates of missed ROP screening decreased from 18.6% in 2005 to 12.8% in 2007. Higher gestational age (OR = 1.25 for increase of 1 week, 95% CI, 1.21-1.29), higher birth weight (OR = 1.13; 95% CI, 1.10-1.15), and singleton birth (OR = 1.2; 95% CI, 1.07-1.34) were associated with higher probability of missing screening. Level II neonatal intensive care units and neonatal intensive care units with lower volume were more likely to miss screenings.

Conclusion

Although ROP screening rates improved over time, larger and older infants are at risk for not receiving screening. Furthermore, large variations in screening rates exist among hospitals in California. Identification of gaps in quality of care creates an opportunity to improve ROP screening rates and prevent impaired vision in this vulnerable population.

Section snippets

Methods

This cross-sectional study used CPQCC data from 2005-2007. The CPQCC collects data in a prospective manner for neonates born at member hospitals in California. Membership is offered to any hospital in California that provides neonatal intensive care. During the study period, eligible patients were cared for in 126 member hospitals, representing more than 90% of NICUs. Data are abstracted by NICU personnel including physicians, nurses, and other trained data abstractors. Annual training sessions

Results

The final cohort eligible for the screening consisted of 13 282 infants with mean gestational age 28.1 weeks (SD 2.3 weeks) and 5th and 95th percentiles at 24 and 31 weeks, respectively. The eligible cohort had mean birth weight of 1101 g (SD 303 g) and 5th and 95th percentiles at 620 and 1545 g, respectively.

The rates of missed ROP screening decreased over time from 18.6% in 2005 to 12.8% in 2007 (P < .0001). Individual hospital screening rates varied widely for all years. When examining

Discussion

Our study of California NICUs revealed that a significant number of eligible patients did not receive ROP screening as suggested by the guidelines developed by the AAP, AAO, and AAPOS. These findings are concerning, as screening identifies infants who should be treated, and the importance of treating ROP has been repeatedly demonstrated in improving structural and visual outcomes.7, 10, 16 We also identified several individual level risk factors that put patients at higher risk of missing

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    Supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development (K23HD068400), NIH LRP (1 L40 EY021928-01), and NIH/NCRR/OD UCSF-CTSI (KL2 RR024130). Data management was funded in part by a community grant from the March of Dimes California Chapter. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding bodies. The authors declare no conflicts of interest.

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