Incidence and Risk Factors for Retinopathy of Prematurity at a Rural Tertiary Hospital in Thailand

Abstract

Purpose: To estimate the incidence and identify the factors affecting retinopathy of prematurity (ROP) in a rural tertiary hospital in Thailand. Methods: This retrospective chart review included all infants screened for ROP. The study included all infants with gestational age (GA) ≤ 30 weeks or birth weight (BW) ≤ 1,500 gr or selected larger infants with an unstable clinical course. Retinal findings were classified according to the revised International Classification of ROP. Data were analyzed using univariate and multivariable logistic regression analyses. Results: Of the 113 screened infants, the incidences of any ROP and ROP requiring intervention were 17.7% and 8.8%, respectively. In univariate analysis, lower GA, lighter BW, total days of supplemental oxygen, days of continuous positive airway pressure (CPAP), presence of apnea, and intraventricular hemorrhage (IVH) were associated with the development of any ROP. In the stepwise multivariable logistic regression analysis, lighter BW, male gender, and bronchopulmonary dysplasia (BPD) were significant risk factors for the development of any ROP. Lower GA and being either a twin or triplet were significant risk factors for ROP requiring intervention. However, no antenatal condition was identified as a risk factor for ROP. Conclusion: The incidence of ROP in rural tertiary hospitals was relatively high as compared with previously published data from urban tertiary hospitals. Lighter BW, male gender, and BPD were significantly associated with the development of ROP in a local context. Epidemiological studies are necessary to prevent ophthalmic morbidities.

Incidence and Risk Factors for Retinopathy of Prematurity in a Tertiary Hospital in China

“… 25 Mantapond and coworkers reported that multiple birth has been associated with treatment-requiring ROP, but this condition was not associated with any ROP development. 8 Our research results differ from this, possibly due to differences in inclusion criteria. There are also several studies reported that there were no differences between singleton and multiple births.…”

“…This result was the same as the studies of Yang’s and Mantapond’s. 7 , 8 Other studies had also reported this result. 21 , 22 A study showed that male fetal sex was associated with higher maternal levels of pro-inflammatory cytokines and angiogenic factors including VEGF during pregnancy, suggesting potential harmful effects on development of ROP in male infants.…”

“…5 , 6 Some studies also showed that gender and multiple pregnancies were risk factors for ROP. 7 , 8 …”

Variations in medical practice of retinopathy of prematurity among 8 Asian countries from an international survey

“…For infants born at and after 31 +0 weeks’ GA with birthweight less than 1501 g, the first ROP examination should be performed at 36 weeks’ PMA or 4 completed weeks’ postnatal age (28–34 days), whichever is earlier. When Asian countries were compared to US and UK, the published screening criteria for GA were < 34 weeks’ GA in Indonesia 26 , ≤ 32 weeks’ GA in Philippines 27 and Singapore 28 , < 32 weeks’ GA in Malaysia 29 and Taiwan 30 , < 31 weeks’ of gestation in Japan 31 , and < 30 weeks’ of gestation in South Korea 32 and Thailand 19 . Majority of NICUs conducted ROP screening to infants with birth weight < 1500 g.…”

“…Most countries like in Asia, Japan 31 , South Korea 32 , Malaysia 29 , Phillipines 27 , Singapore 28 , Taiwan 30 , and Thailand 19 follow screening guidelines similar to the UK/US: all infants with GA of 30–32 weeks or less and/or with a birth weight of ≤ 1500 g or less should be screened for ROP. However, in Indonesia, infants with higher GA, < 34 weeks of gestation, are screened 26 .…”