We were interested to read Dhaliwal et al's article published May 2009 comparing retinopathy of prematurity (ROP) in small-for-gestational age (SGA) infants compared with those of appropriate size for gestational age (AGA) which showed that SGA babies born at 26 to 31 weeks' gestation were more likely to develop any stage of ROP or severe ROP1.

We would like to increase awareness of the possibility that SGA infants are also at risk of developing early severe ROP.

On our tertiary neonatal unit a 29 week gestation infant with birth weight (BW) < 0.4th centile was noted to have stage 3 plus ROP bilaterally requiring laser therapy at first ROP screen at 6 weeks. This prompted us to collect data on all infants born January 2003 - September 2005 of gestation <31 weeks gestation and/or BW <1500gms (n=162). We looked at the characteristics of the 87 babies who completed their ROP screening in Cambridge. Of the 87 babies, 11 had BW < 9th centile and 76 had BW > 9th centile. Of the infants with BW < 9th centile, 2 had stage 3 and/or plus disease at first screen (mean age 6.1 weeks). By comparison, none of the infants with BW > 9th centile had stage 3 ROP or plus disease at the time of first screen (mean age 7.1 weeks). We showed that the mean PNA at laser treatment in the < 9th centile group was 6.5 weeks as compared with 10.9 weeks in the infants with BW > 9th centile2.

We concluded that SGA (< 9th centile) infants are at risk of developing severe ROP earlier than their counterparts. We therefore, in conjunction with our ophthalmology team, altered practice at our centre to ensure that the first ROP screen is carried out at 4 weeks PNA for those infants with BW < 9th centile.

Of note, the revised 2008 Royal College of Ophthalmology and RCPCH guideline on management of ROP also reviewed evidence to date and now recommends that any infant born <32 weeks gestation but with a BW <1501g should undergo earlier ROP screening at 4 ¨C 5 weeks PNA3.

REFERENCES:

1.Dhaliwal CA, Fleck BW, Wright E, et al. Retinopathy of prematurity in small-for-gestational age infants compared with those of appropriate size for gestational age. Arch Dis Child Fetal Neonatal Ed 2009;94:F193- F195.

2.Heckford E, Curley A. Are neonates born small for gestational age at increased risk of developing early retinopathy of prematurity? Early Hum Dev 2007;83:134-135.

3.The Royal College of Ophthalmologists, The Royal College of Paediatrics and Child Health, British Association of Perinatal Medicine. Guideline for the Screening and Treatment of Retinopathy of Prematurity, 2008, www.rcophth.ac.uk.

Competing interests: None