Legal Briefs: Blindness From Retinopathy of Prematurity

A 535-g 24-weeks’-gestation boy, twin a, is delivered by cesarean delivery to a 31-year-old G1P0 woman. Her pregnancy was complicated by a twin-to-twin-transfusion, emerging intrauterine growth retardation in twin A, 4-day rupture of membranes, and premature labor. The infant was delivered after a full course of antenatal steroids. The Apgar scores were 5 and 7 at 1 and 5 minutes, respectively. The infant received surfactant replacement therapy in the delivery room and a transfusion several hours after birth for a hematocrit level of 25% (0.25). He did not require further surfactant dosing, but was receiving assisted ventilation for approximately 6 weeks. He had a benign neonatal course.

The neonatologist consulted an ophthalmologist to do the screening examinations for retinopathy of prematurity (ROP). The first examination was done timely according to the American Academy of Pediatrics and the American Ophthalmology Guidelines, and it was performed at 6 weeks when the infant was 30 weeks old. The evaluation revealed incomplete vascularization, documented by the ophthalmologists as “fetal fundi.” The next examination was when the child was 8 weeks, or 31 6/7 weeks’ postmenstrual age (PMA). The findings were reported to be ROP “grade” II zone II OS, no plus disease. No diagrams were used in the charting. The plaintiff neonatologist and ophthalmologists were critical about the ophthalmologist not using the terminology of the International Classification of Retinopathy of Prematurity (ICROP). They maintained that ROP should be described by severity by using the term “stage,” not grade and Roman numerals I, II, and III. A properly documented ROP examination would include drawings of the retinas with specific standardized methods of diagramming the location and extent of the stages. Failures to indicate the ROP demonstrated that the ophthalmologist was, at best, only casually familiar with ICROP. Because the ICROP is the foundation …