Neonatologists' practices and experiences in arranging retinopathy of prematurity screening services

BACKGROUND. Neonatologists play a central role in identifying infants who require screening for retinopathy of prematurity and in coordinating screening and treatment when necessary. No previous study has evaluated neonatologists' practices or experiences related to these activities. METHODS. A national mail survey of a random sample of 300 neonatologists was conducted from September to November 2006. RESULTS. The response rate was 62%. Nearly all ( 98%) of the respondents considered gestational age to identify infants for retinopathy of prematurity screening. However, only 19% used the currently recommended gestational age criterion of 30 weeks; instead, 6% used a lower, more-restrictive criterion, and 74% used a higher, more-inclusive criterion. Fewer respondents ( 77%) considered birth weight to identify infants for retinopathy of prematurity screening, most of whom ( 86%) used the current criterion of <= 1500 g. Although more than one half ( 67%) of the respondents reported that pediatric ophthalmologists usually screen infants for retinopathy of prematurity in their NICU, nearly one half ( 46%) reported that retinal specialists provide treatment. Some ( 36%) reported that they have been unable to transfer a child to a NICU of lower acuity or closer to the child's home because there are no specialists available there for retinopathy of prematurity screening. Some ( 34%) also reported that they have needed to delay discharge because outpatient follow-up for either screening or treatment of retinopathy of prematurity is not available near the family's home. CONCLUSIONS. We found variations in how children are identified for retinopathy of prematurity screening and how screening and treatment are provided. Future research is needed to understand how these variations affect visual outcomes and costs of care. Such work must also consider the impact of regional pediatric eye care workforce shortages on retinopathy of prematurity screening and treatment strategies.