New guideline for preventing serious visual impairment

Many extremely preterm babies will develop some degree of retinopathy of prematurity (ROP) with most cases never progressing beyond mild disease and resolving spontaneously without treatment. However, a small proportion develop potentially severe ROP, which can be detected through retinal screening. If untreated, severe disease can result in serious vision impairment and consequently all babies at risk of sight-threatening ROP should be screened on time.

This evidence-based guideline is an update of the 2008 UK Screening and treatment of retinopathy of prematurity; it considers the significant changes in both the clinical and organisational aspects of neonatal care that have taken place over the previous 14 years.

A summary of the changes:

• Screening criteria: the gestational age criterion for screening has been reduced from 32 weeks to 31 weeks as based on more recent published evidence. The birthweight criterion of less than 1,501g has not changed.

• Timing of first examination: precise timing of the first examination is stated.

• Preparation for screening: greater detail is included related to the preparation for screening, including consent, comfort care and pain relief during the screening examination.

• Follow up examinations: when necessary, the importance of attending follow-up examinations is emphasised. The need for appropriate resuscitation equipment and trained staff is stated for outpatient examinations.

• Referral for treatment: details of when to refer for treatment are specified.

• Record keeping and communications with others: there is emphasis throughout the guideline on record keeping and communication both with parents/carers and between professionals as well as the role of a ROP service coordinator.

• Updated tools: a new algorithm for observations and a screening record form are included.

• Comprehensive appendices: these give full details of the guideline scope, methodology and development.

Also available are a printable examination recording form, summary of recommendations and an information leaflet for parents and carers.

To read the guideline visit: www.rcpch.ac.uk/sites/default/files/2022-03/UK-screening-retinopathy-prematurity-guideline.pdf