Objective:

To evaluate the efficacy of a single objective screening criterion—birth weight (BW) < 2000g or gestational age (GA) < 32 weeks—for retinopathy of prematurity (ROP) detection, emphasizing the need to reduce over-screening caused by subjective clinical judgment.

Key Findings:

• 705 ROP cases (48.5%) and 370 severe ROP cases (25.5%) were identified, with statistical significance noted.
• The objective group covered 98.2% of ROP cases and 99.2% of severe ROP cases, both statistically significant.
• ROP and severe ROP prevalence were significantly higher in the objective group than in the subjective group (both P < 0.001).
• Lower GA (OR = 1.42 per week decrease) and lower BW (OR = 1.21 per 100 g decrease) were identified as independent risk factors for severe ROP.

Interpretation:

The single objective criterion of BW < 2000g or GA < 32 weeks can effectively identify the high-risk population for ROP, while subjective extended screening has minimal clinical value in tertiary neonatal care institutions, suggesting a need for practice change.

Limitations:

• The study was conducted in a single center, which may limit generalizability and the applicability of findings to other settings.
• Potential biases in retrospective data collection.

Conclusion:

It is recommended that the subjective high-risk clause may be cautiously omitted in clinical practice within tertiary hospitals with advanced neonatal care capabilities, highlighting the importance of this change.