Eleven years of retinopathy of prematurity in one neonatal intensive care unit in Jakarta, Indonesia

Siswanto, Johanes Edy; Widodo, Nani H; Sauer, Pieter

doi:10.1136/archdischild-2017-314094

Cited by 8 publications

(9 citation statements)

References 7 publications

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“…As a reference in this paper, we used data from one referral hospital as well as data from the literature. The rates of ROP found in one hospital in Indonesia 1 and the studies done in other centres 2 all showed a high incidence of ROP in the period before 2015. Therefore, we are convinced that the incidence of ROP was indeed much higher than suggested by the results of this survey.…”

Section: Discussionmentioning

confidence: 74%

“…1 2 In that previous period, we found in one NICU a 40% incidence of all-stage ROP in infants below 28 weeks and a 28% incidence in the group aged 28-32 weeks. 1 Other studies from the period 2005-2015 in Indonesia found a ROP incidence of 18%-30% in infants born before 32 weeks and/or with a birth weight of less than 1500 g. 2 Different factors may have contributed to this marked decline in ROP. First, a national guideline for ROP prevention and screening was published in 2010.…”

Section: Discussionmentioning

confidence: 98%

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Multicentre survey of retinopathy of prematurity in Indonesia

Siswanto

Bos

Dijk

et al. 2021

bmjpo

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BackgroundThe incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants.ObjectiveTo evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia.SettingData were collected from 34 hospitals with different levels of care: national referral centres, university-based hospitals, and public and private hospitals.MethodsA survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016–2017 in relation to gestational age and birth weight.ResultsWe identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28–32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%–5%. Both mortality and the incidence of ROP were highest in university-based hospitals.ConclusionsIn the 2016–2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016–2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 98%

Multicentre survey of retinopathy of prematurity in Indonesia

Siswanto

Bos

Dijk

et al. 2021

bmjpo

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“…Based on the studies on ROP conducted in Indonesia and other literature, 3‐5,61,62 we propose the following guideline to prevent and screen preterm infants for ROP. The abbreviation “R1O2P3” is used to facilitate the procedures that must be standard practice in all perinatal/neonatal units (Figure 3).…”

Section: Stop: R1o2p3mentioning

confidence: 99%

“…56,57,59,60 In all HIC guidelines, laser treatment is the first treatment; second is intra-vitreal injection with anti-vascular endothelial growth factor (VEGF). This intervention might cause more myopia later, and there is doubt about its safety for disturbed angiogenesis in other Based on the studies on ROP conducted in Indonesia and other literature, [3][4][5]61,62 we propose the following guideline to prevent and screen preterm infants for ROP. The abbreviation "R1O2P3" is used to facilitate the procedures that must be standard practice in all perinatal/neonatal units (Figure 3).…”

Section: Rop Treatmentmentioning

confidence: 99%

“…Also, concerning is the incidence of ROP in our patients with a GA of 28 to 32 weeks where any stage ROP was found in 29%, and stage >3 ROP in 3% of the screened infants. 4 In comparison, the incidence of any stage ROP in developed countries (NMR <5) is approximately 21.8% in infants with a gestational age of less than 32 weeks 5 and the incidence of ROP III-V in infants with a gestational age of less than 26 weeks is 10%. 6 Many studies have shown that there are three main risk factors for the development of ROP.…”

Section: Introductionmentioning

confidence: 99%

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How to prevent ROP in preterm infants in Indonesia?

Siswanto

Dijk

Bos

et al. 2021

Health Science Reports

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Background and Aims Retinopathy of prematurity (ROP) is a severe disease in preterm infants. It is seen more frequently in Low‐Middle Income Countries (LMIC) like Indonesia compared to High‐Income Countries (HIC). Risk factors for ROP development are ‐extreme‐ preterm birth, use of oxygen, neonatal infections, respiratory problems, inadequate nutrition, and blood and exchange transfusions. In this paper, we give an overview of steps that can be taken in LMIC to prevent ROP and provide guidelines for screening and treating ROP. Methods Based on the literature search and data obtained by us in Indonesia's studies, we propose guidelines for the prevention, screening, and treatment of ROP in preterm infants in LMIC. Results Prevention of ROP starts before birth with preventing preterm labor, transferring a mother who might deliver <32 weeks to a perinatal center and giving corticosteroids to mothers that might deliver <34 weeks. Newborn resuscitation must be done using room air or, in the case of very preterm infants (<29‐32 weeks) by using 30% oxygen. Respiratory problems must be prevented by starting continuous positive airway pressure (CPAP) in all preterm infants <32 weeks and in case of respiratory problems in more mature infants. If needed, the surfactant should be given in a minimally invasive manner, as ROP's lower incidence was found using this technique. The use of oxygen must be strictly regulated with a saturation monitor of 91‐95%. Infections must be prevented as much as possible. Both oral and parenteral nutrition should be started in all preterm infants on day one of life with preferably mothers' milk. Blood transfusions can be prevented by reducing the amount of blood needed for laboratory analysis. Discussion Preterm babies should be born in facilities able to care for them optimally. The use of oxygen must be strictly regulated. ROP screening is mandatory in infants born <34 weeks, and infants who received supplemental oxygen for a prolonged period. In case of progression of ROP, immediate mandatory treatment is required. Conclusion Concerted action is needed to reduce the incidence of ROP in LMIC. "STOP ‐ R1O2P3" is an acronym that can help implement standard practices in all neonatal intensive care units in LMIC to prevent development and progression.

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