Scholars@Duke publication: Revisiting retinopathy of prematurity screening criteria to safely reduce infant stress and provider burden at an academic neonatal intensive care unit: a proof-of-concept study.

Revisiting retinopathy of prematurity screening criteria to safely reduce infant stress and provider burden at an academic neonatal intensive care unit: a proof-of-concept study.

Publication , Journal Article

Donaldson, RA; Freedmanat, SF; Pittman, CR; Stinnett, SS; Cotten, CM; Prakalapakorn, SG

Published in: J AAPOS

March 23, 2026

BACKGROUND: Current United States retinopathy of prematurity (ROP) screening guidelines may be overly broad at the cost of undue preterm infant stress and physician workload. Our proof-of-concept study aimed to optimize screening criteria at our institution simply by modifying gestational age (GA) and birth weight (BW) cutoffs to examine the fewest number of infants while including all who developed stage ≥3 and/or treatment-requiring ROP (ie, "must-screen" infants). METHODS: We conducted a retrospective chart review of all infants who began ROP screening at our institution from January 21, 2014 through December 31, 2023. We collected GA, BW, highest ROP stage, and ROP treatment status, noting postmenstrual age (PMA) at first treatment. Using an iterative process, varying GA and BW cutoffs, we determined "optimized" screening criteria that minimized the number of infants examined without excluding any must-screen infants. RESULTS: Of 1,274 infants examined for ROP, 206 (16.2%) must-screen infants developed stage 3 ROP without treatment (n = 49) and/or were treated (n = 157), with maximum GA of 29.0 weeks, maximum BW of 1,360 g, and minimum PMA at first treatment of 31 weeks and 6 days. Using an iterative process, optimized screening criteria included infants with GA of ≤29.0 weeks OR BW of ≤600 g, allowing 327 infants (25.7%) to forego ROP examinations without excluding any who developed stage ≥3 or treatment-requiring ROP. CONCLUSIONS: At our institution, applying optimized screening criteria with reduced GA and BW cutoffs could have safely reduced the number of infants examined by 25.7%. This result suggests that revision of current US ROP screening guidelines is reasonable and may help optimize screening efficiency without excluding high-risk infants.