Validation of the SCREENROP Criteria for Retinopathy of Prematurity Screening: A Canadian Model for Consideration

PURPOSE: Reducing unnecessary retinopathy of prematurity (ROP) screenings in neonates is important for minimizing morbidity associated with such examinations including pain for the child, anxiety in parents, and conserving healthcare resources. The Seminal Canadian Recommendations for Evidence-Based Examination of Neonates for Retinopathy of Prematurity (SCREEN-ROP) guidelines recommend only screening babies with birth weight (BW) <1200 g or gestational age (GA) <30 weeks to prevent unnecessary screenings. This study aims to retrospectively test the sensitivity of SCREEN-ROP in a large urban Canadian setting for capturing babies requiring treatment for ROP. DESIGN: Retrospective accuracy analysis of revised diagnostic testing criteria. METHODS: All babies born at McMaster Children Hospital from July 1, 2016 to May 31, 2024 who: 1) received at least one ROP eye exam, or 2) received ROP treatment, were included. Birth weight (BW) and gestational age (GA) at birth were collected from Canadian Neonatal Network (CNN) and BORN Ontario, which stores all information on babies admitted to level 3 and level 2 Neonatal Intensive Care Units (NICUs), respectively. SCREEN-ROP criteria were applied to the cohort. Institutional ethics approval was obtained from Hamilton Integrated Research Ethics Board (REB #13216-C) and CNN (REB #04-062). RESULTS: Sensitivity and specificity of the model was calculated with 95% confidence intervals. Chi-squarede test was used to compare the babies captured with SCREEN-ROP criteria versus prior criteria (GA<31 weeks or birth weight <1251 g). 823 unique babies were screened from July 1, 2016 to May 31, 2024 of which 79 unique babies were treated for ROP. Applying the SCREEN-ROP criteria captured all 79 babies requiring ROP treatment while avoiding another 61 babies (7.41%) from being unnecessarily enrolled into ROP screening. Sensitivity of SCREEN-ROP criteria for capturing babies requiring ROP treatment was 100% (95% CI: 95.44% to 100%), and the specificity was 8.20% (95% CI: 6.33% to 10.41%). CONCLUSIONS: By screening babies with BW <1200 g or GA <30 weeks, 7.41% of babies would have been saved from unnecessary ROP screenings, and all babies requiring ROP treatment would have been captured with 100% sensitivity. Further validation in other large centers and countries may allow for broader implementation of SCREEN-ROP guidelines.