Retinopathy of Prematurity (ROP)

Screening Criteria

• All infants with birth weight (BW) <= 1500 grams
• All infants with gestational age (GA) <= 30 weeks
• Selected infants BW 1500-2000g or > 30 weeks with unstable clinical course (at attending discretion)
• First examination timing: Postmenstrual age 31 weeks OR 4 weeks postnatal age (whichever is LATER)

Examination Logistics

• Administer mydriatic drops (cyclopentolate/phenylephrine) 30-60 minutes prior
• Monitor for apneic or bradycardic spells during and post-exam
• Provide comforting measures: sucrose pacifier, swaddling
• Document: Zone (I, II, III), Stage (1-5), and presence of 'Plus' disease (tortuous and dilated vessels)

Management & Treatment

• Threshold disease (or Type 1 ROP): Requires urgent treatment within 72 hours
• Primary treatment modalities: Laser photocoagulation of the avascular retina
• Alternative emerging treatment: Anti-VEGF intravitreal injection (Bevacizumab/Ranibizumab) - primarily for Zone 1 or aggressive posterior ROP
• Follow-up is mandatory post-discharge until retina is fully vascularized (Zone III)

Ophthalmic Extracted Protocol

• Darken the room fully. Minimize ambient light prior to exams.
• Mydriatic drops: Administer Cyclomydril (cyclopentolate 0.2% / phenylephrine 1%) 1 drop per eye, repeat in 10 minutes if pupils are not fully dilated.
• Monitor vital signs continuously during examination; oculocardiac reflex can trigger profound bradycardia.
• Post-procedure: Administer prophylactic ophthalmic antibiotic drops strictly as prescribed for 3 days post-injections or laser.

Standardized Discharge & Follow-Up Criteria

• Adequate weight gain explicitly > 15-30g/day over a continuous 3-5 day period.
• Maintenance of temperature in an open crib with standard clothing for 48 hours.
• Successful completion of the 90-120 minute Infant Car Seat Challenge.
• Caregiver successfully completed CPR training, rooming-in, and independent medication administration.
• Referrals placed for High-Risk Infant Follow-Up Clinic, Early Intervention (PT/OT), and appropriate sub-specialists.

Diagnostic & Management Algorithm

• ROP Screening Timeline Flowchart: [START] Infant < 30 weeks OR < 1500g -> [CALCULATION] First exam occurs at Postmenstrual Age (PMA) 31 weeks OR Chronological age 4 weeks (whichever is LATER) -> [RESULTS] Immature vessels, no ROP -> [ACTION] Re-examine strictly every 2 weeks until vascularization completes to Zone III

References

1. Fierson WM, American Academy of Pediatrics Section on Ophthalmology, American Academy of Ophthalmology, etc. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics.
2. Early Treatment For Retinopathy Of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol.