Objective. To determine appropriate upper limits for gestational age and birth weight when screening infants for retinopathy of prematurity (ROP). Design. Retrospective survey. Setting. Tertiary neonatal intensive care nursery. Patients. Seven hundred seven infants born July 1, 1990 to June 30, 1996 and screened for ROP according to the 1988 to 1996 American Academy of Pediatrics guidelines. Outcome Measures. Maximum stage of ROP with respect to birth weight and gestational age. Results. No ROP more than Stage 1 was observed in infants with gestational ages ≥32 weeks or birth weights ≥1500 g. All cases of threshold and Stage 4 ROP were confined to infants with gestational ages ≤30 weeks or birth weights <1200 g. Conclusions. The latest American Academy of Pediatrics screening guidelines for ROP are discretionary for infants with birth weights >1500 g or gestational ages >28 weeks. If ROP screening is limited to infants with birth weights of ≤1500 g, 34.2% fewer infants would require screening compared with the previous <1800 g recommendation, while missing no cases of ROP more than Stage 1. A gestational age cut-off of ≤28 weeks, however, is less desirable, and could potentially miss several infants with more advanced retinopathy (including Stage 4). If ROP screening criteria were instead modified to include infants of gestational ages <32 weeks, the number of patients requiring screening could be reduced 29.1% compared with the previous recommendation of <35 weeks, again without missing any cases of ROP more than Stage 1. Use of such a screening strategy (birth weight <1500 g or gestational age <32 weeks) is predicted to save in excess of 1.5 million dollars annually in the United States, while missing no cases of ROP more than Stage 1.

Multiple clinical trials of surfactant have demonstrated reductions in neonatal mortality (M). With improved survival in an era of increased cost-containment, we questioned if M reduction would be offset by increasing lengths of stay (LOS). Methods: The records of all ICN admissions to UT with birth weight (BW) ≤ 1500 g in 1986-1989 (pre-surfactant era, n=403) and 1991-1995 (post-surfactant era, n=422) were retrospectively compared. M and LOS were computed for the BW classes: 251-500 g, 501-750 g, 751-1000 g, 1001-1250 g, 1251-1500 g, and 251-1500 g. Differences in M and LOS were calculated using the chi-square and t test, respectively.Results: Overall M, reduced by 28.7% in the post-surfactant period, was accompanied by a 7.5% increase in mean LOS for all patients(Figure 1), the increase primarily due to greater LOS in nonsurvivors. If only surviving infants were examined, no differences in LOS were found. When only nonsurviving infants were considered, although not statistically significant, the average LOS nearly doubled for all infants with birth weights ≤ 1000 g (Figure 2). For the nonsurviving 751-1000 gram infants, this equated to an average postponement in death of 3 weeks. The costs (monetary, psychological, physical, and emotional) of such extended deaths to the patients, families, medical team, and society are difficult to quantify, but appear to be one of the many prices of success for improved survival in the post-surfactant era.

OBJECTIVE:To determine if glucocorticoid therapy alters the severity of retinopathy of prematurity (ROP).DESIGN:Retrospective survey.SETTING:Tertiary intensive care nursery.PATIENTS:One hundred forty-seven surviving infants with birth weight of 1.25 kg or less born July 1990 through January 1993.OUTCOME MEASURES:Maximum stage of retinopathy and the need for cryosurgery.RESULTS:Using logistic regression, neither corticosteroid exposure nor total corticosteroid dose was associated with either ROP greater than stage 2 or cryosurgery. The significant predictors of ROP greater than stage 2 were birth weight and the duration of supplemental oxygen therapy. The only significant risk factor for cryosurgery was gestational age.CONCLUSIONS:No association between corticosteroid therapy and the severity of ROP was found after controlling for traditional risk factors such as birth weight, gestational age, and duration of supplemental oxygen therapy.

OBJECTIVE To generate contemporary postnatal growth curves for hospitalized very low birth weight infants. DESIGN Retrospective survey. SETTING Tertiary intensive care nursery. PATIENTS All surviving singleton, appropriate-for-gestational age infants with birth weight < or = 1500 g, born January 1, 1987, to May 31, 1991, who did not develop necrotizing enterocolitis (N = 205). MEASUREMENTS AND RESULTS Macronutrient intakes and body weights were recorded daily, with crown-heel length and occipital-frontal head circumference recorded weekly up to 105 days of age or hospital discharge, whichever occurred first. Growth curves were generated for four birth weight ranges: 501 through 750, 751 through 1000, 1001 through 1250, and 1251 through 1500 g. Compared to previously published growth curves, the current infants regained birth weight more quickly and exhibited larger average daily weight gains. These differences were most apparent in infants of lowest birth weight. CONCLUSIONS The "premature growth grid" constructed by Dancis et al more than 40 years ago may no longer be a useful standard of early postnatal growth for present-day very low birth weight, appropriate-for-gestational-age infants. The new weight curves are a more accurate reflection of current in-hospital growth trends, especially for infants weighing < or = 1000 g at birth.