At what age should a 2-month-old male born at 35 weeks gestation be evaluated by ophthalmology for Retinopathy of Prematurity (ROP)?

Ophthalmologic Evaluation Timing for Retinopathy of Prematurity in a 2-Month-Old Born at 35 Weeks

For a 2-month-old male born at 35 weeks gestation, ophthalmologic screening for retinopathy of prematurity (ROP) is not routinely recommended as infants born at >34 weeks gestation generally do not require ROP screening. 1, 2

ROP Screening Criteria

Gestational Age Considerations

• Infants born at >37 weeks gestation do not require ROP screening 1
• Infants born between 29-37 weeks gestation do not require screening if they had a "medically stable" course (no supplemental oxygen requirement) 1
• A more conservative approach is to screen all infants with <32 weeks gestation, even if stable 1
• Current guidelines from the American Academy of Pediatrics recommend screening for:
  • Infants weighing less than 1500 grams OR
  • Infants with gestational age ≤34 weeks 2

Timing of Initial Examination

For infants who do meet screening criteria, the first examination should occur at:

• 31-33 weeks postmenstrual age OR
• 4 weeks chronological age, whichever is later 1, 2, 3

Application to This Patient

For this 2-month-old infant born at 35 weeks gestation:

• The infant is beyond the gestational age threshold for routine ROP screening (>34 weeks)
• Unless the infant had specific risk factors such as:
  • Prolonged oxygen requirement
  • Unstable clinical course
  • Other significant comorbidities

Special Considerations

Medical Stability Assessment

• If the infant had an unstable medical course with prolonged oxygen requirement, screening might be considered despite being born at 35 weeks 1
• The American Thoracic Society notes that it is rare for an infant with Chronic Lung Disease of Infancy to have been medically stable during initial hospital weeks 1

Risk Stratification

• Lower risk of developing clinically significant ROP is associated with:
  • Higher birth weight (>750g)
  • Higher gestational age (>27 weeks) 4
• This infant, born at 35 weeks, falls into a very low-risk category

Follow-up Recommendations

If the infant has already had an initial ROP screening that showed no evidence of ROP:

• Surveillance can be discontinued if:
  • The infant has reached 45 weeks postmenstrual age without development of prethreshold ROP
  • Retinal vascularization has progressed into zone III without previous zone II ROP
  • Full retinal vascularization has occurred 3

Conclusion

Based on current guidelines, this 2-month-old infant born at 35 weeks gestation does not require routine ROP screening unless there were specific risk factors such as prolonged oxygen requirement or unstable clinical course. If there is clinical concern, consultation with an ophthalmologist experienced in ROP evaluation would be appropriate to determine if an examination is warranted.