Delays and loss to follow-up in outpatient retinopathy of prematurity screening

PURPOSE: To determine the frequency and determinants of delayed and complete loss to follow-up (LTFU) for the first outpatient retinopathy of prematurity (ROP) examination after discharge at a single tertiary center. METHODS: A retrospective chart review of neonates at a single institution from 2014 to 2023 who underwent inpatient ROP screening and were intended to have outpatient follow-up there within 1 month was performed. Frequency of LTFU and delayed follow-up (>3 days) were calculated, and univariate logistic regression revealed potential associations with clinical and sociodemographic factors. Qualitative themes were extracted to identify reasons for gaps. RESULTS: Of the 721 infants who met inclusion criteria, 691 (95.8%) received follow-up, although 12.9% of those receiving follow-up were delayed by a median of 9 days. Zone III ROP or retinal maturity on inpatient screening was associated with complete LTFU (OR = 0.20; 95% CI, 0.09 - 0.45). Postmenstrual age at discharge ≥40 weeks was also associated with LTFU (OR = 0.31; 95% CI, 0.14-0.65), but among those with follow-up, it was more likely to be timely (OR = 1.84; 95% CI, 1.08-3.30). Inpatient ROP treatment was associated with timeliness of follow-up (OR = 5.27; 95% CI, 1.11-94.2); Hispanic or non-White race/ethnicity was associated with delays (OR = 0.44; 95% CI, 0.28-0.69). CONCLUSIONS: Despite an overall high rate of follow-up, delays remain a challenge that may disproportionately affect Hispanic or non-White patients. ROP severity may be associated with better follow-up. Although these findings are exploratory, they may inform future research and interventions to ensure uninterrupted care for all patients.