Identification of treatment-warranted retinopathy of prematurity by neonatal nurse specialist

Abstract

ObjectiveTo determine the accuracy in the identification of infants with treatment-warranted retinopathy of prematurity (ROP) by a trained and experienced ROP neonatal nurse specialist compared with skilled ophthalmologists.MethodsA single-centre, prospective, blinded, agreement study was performed on a cohort of infants undergoing ROP screening. An experienced ROP neonatal nurse specialist obtained retinal images using a wide field digital retinal imaging system (WFDRI) on 127 infants and identified those with treatment-warranted ROP. This interpretation was compared with the interpretation of the same images by skilled ophthalmologists. The accuracy of the ROP nurse specialist’s interpretation was assessed for sensitivity and specificity compared with the gold standard interpretation by the ophthalmologists.ResultsThe ROP nurse specialist performed 345 ROP screens on both eyes of 127 infants. The mean (SD) gestation age (weeks) and birth weight (g) of the infants screened was 26.8 (2.8) and 929 (327), respectively. The nurse specialist correctly identified all 8 infants with treatment-warranted ROP and 118/119 infants without. The sensitivity and specificity (95% CI) of ROP screening episodes were 100% (63% to 100%) and 99.7% (98.4% to 100.0%), respectively.ConclusionA trained and experienced ROP neonatal nurse specialist can correctly identify infants with treatment-warranted ROP using WFDRI. Further work is required to examine the generalisability of this finding and its impact on ROP screening services.