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Optimised retinopathy of prematurity screening guideline in China based on a 5-year cohort study
  1. Qian Yang1,
  2. Xiaohong Zhou2,
  3. Yingqin Ni1,
  4. Haidong Shan3,
  5. Wenjing Shi4,5,
  6. Xuelei Yin6,
  7. Jiangqin Liu6,
  8. Xin Huang1,7
  1. 1 Department of Ophthalmology, Fudan University Eye Ear Nose and Throat Hospital, Shanghai, China
  2. 2 Ophthalmology, Children’s Hospital of Fudan University, Shanghai, China
  3. 3 New Bund Medical and Surgical Center, SinoUnited Health, Shanghai, China
  4. 4 Neonatology, Shanghai Sixth Peoples Hospital, Shanghai, China
  5. 5 Neonatology, International Peace Maternity and Child Health Hospital, Shanghai, China
  6. 6 Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
  7. 7 Shanghai Key Laboratory of Visual Impairment and Restoration, Fudan University, Shanghai, China
  1. Correspondence to Xin Huang, Department of Ophthalmology, Eye and ENT Hospital of Fudan University, 83 Fenyang Road, Shanghai 200031, China; fd2017huangxin{at} and Jiang-Qin Liu, Department of Neonatology, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, 2699 Gaoke West Road, Pudong New District, Shanghai 201204, China; jiangqinliu{at}


Purposes To develop an optimised retinopathy of prematurity (ROP) screening guideline by adjusting the screening schedule and thresholds of gestational age (GA) and birth weight (BW).

Methods A multicentre retrospective cohort study was conducted based on data from four tertiary neonatal intensive care units in Shanghai, China. The medical records of enrolled infants, born from 2012 to 2016 who underwent ROP examinations, were collected and analysed. The incidence and risk factors for ROP were analysed in all infants. Postnatal age (PNA) and postmenstrual age (PMA) of infants, detected to diagnose ROP for the first time, were compared with the present examination schedule. The predictive performance of screening models was evaluated by internally validating sensitivity and specificity.

Results Of the 5606 eligible infants, ROP was diagnosed in 892 (15.9%) infants; 63 (1.1%) of them received treatment. The mean GA of ROP patients was 29.4±2.4 weeks, and the mean BW was 1260±330 g. Greater prematurity was associated with an older PNA at which ROP developed. The minimum PMA and PNA at which diagnosis of treatable ROP occurred were 32.43 and 3 weeks, respectively. The optimised criteria (GA <32 weeks or BW <1600 g) correctly predicted 98.4% type 1 ROP infants, reducing the infants requiring examinations by 43.2% when internally validated.

Conclusions The incidence of type 1 ROP and the mean GA and BW of ROP infants have decreased in China. The suggested screening threshold and schedule may be reliably used to guide the modification of ROP screening guideline and decrease medical costs.

  • Retina
  • Macula
  • Child health (paediatrics)

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  • QY and XZ are joint first authors.

  • Contributors XH and JL conceived and designed the experiments. YN, HS and XH performed the screening and diagnosis of ROP. XZ, WS and XY collected the clinical data. QY and XZ statistically analysed data. QY and XH drafted and revised manuscript. All authors read and approved the manuscript.

  • Funding This study was sponsored by the Natural Science Foundation of Shanghai (17ZR1404500, Shanghai, China). The sponsors and funding organisations had no role in the design or conduct of this research.

  • Competing interests None declared.

  • Data sharing statement Data are available upon reasonable request.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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