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

Step 1: Identify why this baby needs eye screening.
Babies born very early or very small are at risk for retinopathy of prematurity (ROP), a disease of the growing retinal blood vessels that can cause blindness if missed. This infant, born at 27 weeks gestation and weighing 1500 grams, meets the standard screening criteria (birth before about 30 to 31 weeks, or birth weight under about 1500 to 2000 grams).

Step 2: Recall the timing rule for the first screening.
ROP screening is not done on the day of birth, because the abnormal vessel changes take time to appear. The first fundus exam is timed by whichever comes later: about 4 to 6 weeks after birth (chronological age), or when the baby reaches about 31 to 33 weeks of postmenstrual age (gestational age at birth plus weeks lived since birth).

Step 3: Apply the rule to this baby.
This baby was born at 27 weeks gestation. Waiting until the baby is about 6 to 7 weeks old brings the postmenstrual age to roughly 33 to 34 weeks, which is the point recommended for the first look, matching the postmenstrual age rule rather than a fixed calendar count from birth.

Step 4: Rule out the other options.
Examining the eye immediately at birth is too early, since ROP changes have not yet developed and normal immature vessels can be mistaken for disease. A fixed 3 to 4 weeks after delivery ignores how immature this baby is, since a baby born this early needs the postmenstrual age rule, not a flat calendar count. Waiting until 40 weeks gestation period is far too late, since sight threatening ROP can already need treatment well before then.

Step 5: Final Answer.
The first fundus screening for this 27 week premature infant is done at around 34 weeks gestational (postmenstrual) age. \[ \boxed{\text{At 34 weeks gestational age}} \]