A Clinical Prediction Model to Stratify Retinopathy of Prematurity Risk Using Postnatal Weight Gain

OBJECTIVE: To develop an efficient clinical prediction model that includes postnatal weight gain to identify infants at risk of developing severe retinopathy of prematurity (ROP). Under current birth weight (BW) and gestational age (GA) screening criteria, <5% of infants examined in countries with advanced neonatal care require treatment. PATIENTS AND METHODS: This study was a secondary analysis of prospective data from the Premature Infants in Need of Transfusion Study, which enrolled 451 infants with a BW < 1000 g at 10 centers. There were 367 infants who remained after excluding deaths (82) and missing weights (2). Multivariate logistic regression was used to predict severe ROP (stage 3 or treatment). RESULTS: Median BW was 800 g (445–995). There were 67 (18.3%) infants who had severe ROP. The model included GA, BW, and daily weight gain rate. Run weekly, an alarm that indicated need for eye examinations occurred when the predicted probability of severe ROP was >0.085. This identified 66 of 67 severe ROP infants (sensitivity of 99% [95% confidence interval: 94%–100%]), and all 33 infants requiring treatment. Median alarm-to-outcome time was 10.8 weeks (range: 1.9–17.6). There were 110 (30%) infants who had no alarm. Nomograms were developed to determine risk of severe ROP by BW, GA, and postnatal weight gain. CONCLUSION: In a high-risk cohort, a BW-GA-weight-gain model could have reduced the need for examinations by 30%, while still identifying all infants requiring laser surgery. Additional studies are required to determine whether including larger-BW, lower-risk infants would reduce examinations further and to validate the prediction model and nomograms before clinical use.

[1]  R. Whyte.  Neurodevelopmental outcome of extremely low-birth-weight infants randomly assigned to restrictive or liberal hemoglobin thresholds for blood transfusion. , 2012, Seminars in perinatology.

[2]  A. Luini,et al.  A nomogram based on the expression of Ki-67, steroid hormone receptors status and number of chemotherapy courses to predict pathological complete remission after preoperative chemotherapy for breast cancer. , 2010, European journal of cancer.

[3]  A. Pérez-Muñuzuri,et al.  Serum levels of IGF1 are a useful predictor of retinopathy of prematurity , 2010, Acta paediatrica.

[4]  Lois E. H. Smith,et al.  Longitudinal postnatal weight measurements for the prediction of retinopathy of prematurity. , 2010, Archives of ophthalmology.

[5]  P. Royston,et al.  Prognosis and prognostic research: application and impact of prognostic models in clinical practice , 2009, BMJ : British Medical Journal.

[6]  M. Maia,et al.  Weight gain measured at 6 weeks after birth as a predictor for severe retinopathy of prematurity: study with 317 very low birth weight preterm babies , 2009, Graefe's Archive for Clinical and Experimental Ophthalmology.

[7]  Lois E. H. Smith,et al.  Validation of a new retinopathy of prematurity screening method monitoring longitudinal postnatal weight and insulinlike growth factor I. , 2009, Archives of ophthalmology.

[8]  Lois E. H. Smith,et al.  Early Weight Gain Predicts Retinopathy in Preterm Infants: New, Simple, Efficient Approach to Screening , 2009, Pediatrics.

[9]  Yvonne Vergouwe,et al.  Prognosis and prognostic research: Developing a prognostic model , 2009, BMJ : British Medical Journal.

[10]  Yvonne Vergouwe,et al.  Prognosis and prognostic research: what, why, and how? , 2009, BMJ : British Medical Journal.

[11]  C. Gilbert.  Retinopathy of prematurity: a global perspective of the epidemics, population of babies at risk and implications for control. , 2008, Early human development.

[12]  Lois E. H. Smith,et al.  Longitudinal postnatal weight and insulin-like growth factor I measurements in the prediction of retinopathy of prematurity. , 2006, Archives of ophthalmology.

[13]  K. Barrington,et al.  The Premature Infants in Need of Transfusion (PINT) study: a randomized, controlled trial of a restrictive (low) versus liberal (high) transfusion threshold for extremely low birth weight infants. , 2006, The Journal of pediatrics.

[14]  Michael W Kattan,et al.  Postoperative nomogram predicting risk of recurrence after radical cystectomy for bladder cancer. , 2006, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[15]  Stephan Dreiseitl,et al.  Nomographic representation of logistic regression models: A case study using patient self-assessment data , 2005, J. Biomed. Informatics.

[16]  F. Harrell,et al.  Prognostic/Clinical Prediction Models: Multivariable Prognostic Models: Issues in Developing Models, Evaluating Assumptions and Adequacy, and Measuring and Reducing Errors , 2005 .

[17]  G. Quinn,et al.  Characteristics of Infants With Severe Retinopathy of Prematurity in Countries With Low, Moderate, and High Levels of Development: Implications for Screening Programs , 2005, Pediatrics.

[18]  J. Flynn,et al.  Incidence of retinopathy of prematurity from 1996 to 2000: analysis of a comprehensive New York state patient database. , 2004, Ophthalmology.

[19]  W. Tasman,et al.  Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. , 2004, Archives of ophthalmology.

[20]  A. Fielder,et al.  Preliminary results of treatment of eyes with high-risk prethreshold retinopathy of prematurity in the early treatment for retinopathy of prematurity randomized trial. , 2003, Archives of ophthalmology.

[21]  Victor Reuter,et al.  A preoperative nomogram identifying decreased risk of positive pelvic lymph nodes in patients with prostate cancer. , 2003, The Journal of urology.

[22]  Lois E. H. Smith,et al.  Postnatal serum insulin-like growth factor I deficiency is associated with retinopathy of prematurity and other complications of premature birth. , 2003, Pediatrics.

[23]  Lois E. H. Smith,et al.  Selective stimulation of VEGFR-1 prevents oxygen-induced retinal vascular degeneration in retinopathy of prematurity. , 2003, The Journal of clinical investigation.

[24]  K. Ihara,et al.  Physical Growth and Retinopathy in Preterm Infants: Involvement of IGF-I and GH , 2001, Pediatric Research.

[25]  C. Gilbert,et al.  Blindness in children: control priorities and research opportunities , 2001, The British journal of ophthalmology.

[26]  Lois E. H. Smith,et al.  Low IGF-I suppresses VEGF-survival signaling in retinal endothelial cells: Direct correlation with clinical retinopathy of prematurity , 2001, Proceedings of the National Academy of Sciences of the United States of America.

[27]  C. Normand,et al.  Evidence for changing guidelines for routine screening for retinopathy of prematurity. , 2001, Archives of pediatrics & adolescent medicine.

[28]  S. J. Phillips,et al.  Poor postnatal weight gain: a risk factor for severe retinopathy of prematurity. , 2000, Journal of AAPOS : the official publication of the American Association for Pediatric Ophthalmology and Strabismus.

[29]  P. Cohen,et al.  Role of insulin‐like growth factors and their binding proteins in growth control and carcinogenesis , 2000, Journal of cellular physiology.

[30]  Lois E. H. Smith,et al.  Regulation of vascular endothelial growth factor-dependent retinal neovascularization by insulin-like growth factor-1 receptor , 1999, Nature Medicine.

[31]  C R Bauer,et al.  Longitudinal Growth of Hospitalized Very Low Birth Weight Infants , 1999, Pediatrics.

[32]  K. Nicolaides,et al.  Maternal and fetal insulin-like growth factors and their binding proteins in the second and third trimesters of human pregnancy. , 1998, Human reproduction.

[33]  Lois E. H. Smith,et al.  Regulation of vascular endothelial growth factor by oxygen in a model of retinopathy of prematurity. , 1996, Archives of ophthalmology.

[34]  Lois E. H. Smith,et al.  Oligodeoxynucleotides inhibit retinal neovascularization in a murine model of proliferative retinopathy. , 1996, Proceedings of the National Academy of Sciences of the United States of America.

[35]  L. Aiello,et al.  Suppression of retinal neovascularization in vivo by inhibition of vascular endothelial growth factor (VEGF) using soluble VEGF-receptor chimeric proteins. , 1995, Proceedings of the National Academy of Sciences of the United States of America.

[36]  J. Stone,et al.  Vascular endothelial growth factor acts as a survival factor for newly formed retinal vessels and has implications for retinopathy of prematurity , 1995, Nature Medicine.

[37]  A. Fielder.  The natural ocular outcome of premature birth and retinopathy. Status at 1 year. Cryotherapy for Retinopathy of Prematurity Cooperative Group. , 1995, Archives of ophthalmology.

[38]  Lois E. H. Smith,et al.  Vascular endothelial growth factor/vascular permeability factor expression in a mouse model of retinal neovascularization. , 1995, Proceedings of the National Academy of Sciences of the United States of America.

[39]  Karen W. Miller,et al.  Incidence and Early Course of Retlnonathy of Prematurity , 1991 .

[40]  Lanning B. Kline,et al.  Multicenter trial of cryotherapy for retinopathy of prematurity. Preliminary results. Cryotherapy for Retinopathy of Prematurity Cooperative Group. , 1988, Archives of ophthalmology.

[41]  T. Hirose,et al.  An International Classification of Retinopathy of Prematurity: II. The Classification of Retinal Detachment , 1987 .

[42]  R. A. King,et al.  Circulating insulin-like growth factor I levels in newborn premature and full-term infants followed longitudinally. , 1986, Early human development.

[43]  N. Mantel.  Why Stepdown Procedures in Variable Selection , 1970 .

[44]  D. Nemet,et al.  Inflammatory and Growth Mediators in Growing Preterm Infants , 2007, Journal of pediatric endocrinology & metabolism : JPEM.

[45]  J. Folch,et al.  Longitudinal postnatal weight and insulin-like growth factor I measurements in the prediction of retinopathy of prematurity , 2007 .

[46]  A. Fielder,et al.  Retinopathy of prematurity in the UK I: The organisation of services for screening and treatment , 2002, Eye.

[47]  Multicenter trial of cryotherapy for retinopathy of prematurity. Three-month outcome. Cryotherapy for Retinopathy of Prematurity Cooperative Group. , 1990, Archives of ophthalmology.

[48]  Isaac Ben-Sira,et al.  An international classification of retinopathy of prematurity. , 1984, Archives of ophthalmology.