A practical method for reducing blindness due to retinopathy of prematurity in a developing country

Abstract

Background: Retinopathy of prematurity (ROP) is a common cause of blindness in countries with rapidly developing systems of neonatal care. At present, detection and treatment programs are not widely available in many regions of middle- and low-income countries. Subject population: Case series. Methods: An analysis was undertaken to determine in which neonatal intensive care units (NICUs) in Peru babies blind from ROP had been cared for. Demographic and hospital information was gathered for children blind from ROP presenting before the age of 5 years. NICUs with a high likelihood of having ROP-blind children were offered training and equipment designed to improve neonatal care. Results: Ninety-one children with ROP blindness were identified. Twenty-six percent were <1000 g at birth, and 17% had birth weights of >1500 g. Forty-six percent came from NICUs in Lima. Interventional workshops emphasizing neonatal care and oxygen administration have been conducted thus far in six of the 13 largest NICUs in Lima. The percentage of at-risk babies being examined has generally increased, whereas the percentage of babies requiring treatment decreased in three NICUs and increased slightly in two, and no preworkshop data were available in one. Conclusion: This report represents the initial results of an evidence-based approach to decreasing blindness from ROP in Peru. Workshops emphasizing neonatal care, especially targeting oxygen administration, provide methods for improving care of at-risk babies.

Preterm-associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010

“…Oxygen monitoring is routine in high-income countries, but variable in other settings, especially in units that are overcrowded and that lack both equipment and trained nursing staff in adequate numbers (51,52). A preliminary study from Peru suggests that severe ROP has declined since workshops were held for neonatal staff on how to improve the delivery and monitoring of oxygen (53). Infection increases the risk of ROP and should be minimized by strict adherence to infection control measures.…”

Retinopathy of prematurity blindness worldwide: phenotypes in the third epidemic

“…The rate of ROP requiring treatment varied from 4% in a nursery with an infant to nurse ratio of 2:1 compared to a 12% treatment rate in a nursery with an infant to nurse ratio of 17:1 and a 9% treatment rate in a nursery with an infant to nurse ratio of 8:1. Similarly, Gordillo et al19 documented in 2012 that there were more than four times more infants on supplemental oxygen than there were oxygen analyzers available for monitoring therapy. Such conditions set up the likelihood of first epidemic ROP blindness, and addressing these conditions is an ongoing struggle in many of the NICUs in middle- and low-income countries.…”

Retinopathy of prematurity prevention, screening and treatment programmes: Progress in South America

“…2014, 19 and Colombia uses the national health information system (ASIS) to collect data on the number of live born babies with birth weight <1,999 g with a diagnosis of ROP; in 2014 it was 8.3%. 20 Some countries have assessed their ROP programme in a selected group of NICUs; in 7 units in Rio de Janeiro, Brazil in 2010 to identify the characteristics of preterm infants at risk of ROP, 21 in 6 units in Lima, Peru in 2012, 22 and in 32 units in Mexico in 2015. 23…”