Validation of a screening score model to predict the development of retinopathy of prematurity

Retinopathy of prematurity (ROP) is a leading cause of preventable blindness in preterm infants, with a disproportionate burden in low- and middle-income countries. Screening criteria from high-income settings may not be directly applicable in these contexts. We developed and validated two pragmatic risk-based screening models using multicenter Indonesian neonatal data: Model A (FiO₂-based) and Model B (SpO₂-based). Significant predictors included intrauterine growth restriction, oxygen exposure, exchange transfusion, and socioeconomic status. Internal validation showed moderate discrimination (AUC 0.719–0.732) with sensitivities of 77–86% and specificities of 44–58%. The bedside operational score form is presented for clinical use. External validation in 163 infants (gestational age 25–37 weeks, birth weight 600–2000 g) confirmed robust performance, with the combined rule (positive if either model was positive) achieving a sensitivity 84%, a specificity 81%, positive predictive value 76%, and negative predictive value 87%. The pre-test probability of ROP was 0.42, increasing to 0.76 after a positive screen and decreasing to 0.13 after a negative result. These findings support the use of locally validated risk-based scores as a practical complement to gestational age and birth weight criteria, optimizing ROP case finding in resource-limited settings.