Question

While working in the neonatal ICU, your team delivers a premature infant at 27 weeks of gestation, weighing 1500 grams. How soon will you request a fundus examination by an ophthalmologist?

• A. Immediately
• B. 3-4 weeks after delivery
• C. At 34 weeks gestational age
• D. At 40 weeks gestation period

Hint:

For very preterm babies, the first ROP screen is timed by postmenstrual age, about 31-34 weeks, not by a fixed number of weeks after birth.

Answer 1

The Correct Option is C

This question is about when, not whether, to screen a premature baby for retinopathy of prematurity (ROP).

1. Immediately: Too soon. The retinal vessel changes of ROP take weeks to show up, so an exam right after birth would not catch early disease and risks confusing normal immature vessels for disease.
2. 3-4 weeks after delivery: This flat calendar rule ignores how early the baby was born. A baby born at 27 weeks needs the exam timed against its combined age since conception, not a fixed count of weeks after the delivery date.
3. At 34 weeks gestational age: Screening guidelines time the first exam to whichever is later, about 4 to 6 weeks after birth or about 31 to 33 weeks postmenstrual age. For a baby born at 27 weeks, this lands close to 33 to 34 weeks postmenstrual age, matching this option.
4. At 40 weeks gestation period: Far too late. Sight threatening ROP can progress and even need treatment before a baby reaches full term equivalent age.

Postmenstrual age, meaning gestational age at birth plus the weeks the baby has lived, is the number that decides when the retina is developed enough to check meaningfully, and for this baby that points to about 34 weeks.

Let's summarize:

• ROP screening timing is based on postmenstrual age, not the calendar date of delivery.
• A 27 week preemie reaches the screening window at around 33 to 34 weeks postmenstrual age.

So the fundus exam should be requested at about 34 weeks gestational age.