How to prevent ROP in preterm infants in Indonesia?

Abstract

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.

Additional Adverse Perinatal Outcomes With No Effect on Neonatal Mortality and Birth Defects in Pregnancies Conceived by Assisted Reproductive Technology

“…The differences may be associated with population and regional differences or with variations in sample size and research methods. Oxygen exposure, low birth weight, low gestational age, and breathing problems are risk factors for ROP ( 25 , 26 ). Some studies found that babies conceived by ART were more prone to developing ROP than babies conceived naturally, which seemed to be more severe.…”

Systematic review of the guidelines for retinopathy of prematurity

“…A systematic review was carried out during the development of four guidelines 10,25,32,36 (1 LMIC, 2 UMICs, 1 HIC), and was possibly used in developing the Philippine (PAO) guidelines (LMIC). Six documents 29,30,33,37,38,45 used data from national registries or national studies. In ten documents, expert consensus formed the basis of one or more components of the recommendations (4 LMICs, 1 UMIC, 5 HICs).…”

“…25,26,29,31,33,35,37,40,41,[43][44][45][46] In these 13 guidelines and in four further documents, a paediatrician or neonatologist could initiate screening if they considered a newborn to be at risk of ROP if they fell outside the GA and BW criteria. 30,32,36,39 In five countries, 27,28,34,38,42 all indications for screening were clearly defined. The most frequently mentioned risk factors were:…”

“…30,35,44 In 19 (83%) documents, laser treatment was the most frequently cited procedure. 10,[25][26][27][28][29][30][31][32][33]35,36,[38][39][40][42][43][44][45] Fourteen documents also had recommendations on treatment with anti-VEGF agents. 25,26,[28][29][30][31][32][33]35,38,40,42,43,45,46 The Slovakian guidelines mentioned only anti-VEGF treatment.…”

A risk scoring model to predict progression of retinopathy of prematurity for Indonesia

“…Monitoring these risk factors will help to identify the infants who require regular screening to follow the progression of ROP and those who need treatment. It will help identify those infants who need a transfer to a center where trained ophthalmologists are available [9,10]. In this paper, we present two models to detect infants at risk to develop Type 1 ROP.…”