Prevalence, risk factors and pattern of severe retinopathy of prematurity in eastern Madhya Pradesh

Abstract

Purpose: To describe the prevalence, characteristics including risk factors, and pattern of severe ROP from eastern Madhya Pradesh region of India. Methods: In this 5-year retrospective study, Baseline characteristics, systemic risk factors, and findings of ROP screening were noted. Factors associated with severe ROP including aggressive posterior ROP (APROP), stage IV and V ROP were analyzed. Statistical analysis was done using SPSS version 20. Results: Of 763 babies screened, 30% were diagnosed to have ROP. Prevalence of severe ROP was 14.2% (109) of which 60 (55.5%) were classic and 30 (27.7%) were APROP. Eighteen (16.6%) were diagnosed as advanced ROP (stage IV and V). Mean gestational age (GA) and birth weight (BW) for severe ROP were 31.05 weeks and 1.34 kg, respectively which were inversely associated with severe ROP. But a significant 10% of severe ROP were seen in late preterm babies, >34 weeks. Low GA and respiratory distress syndrome (RDS) were significant risk factors for APROP. Most important factor for stage IV and V ROP was late presentation for screening. Conclusion: The study found a high prevalence of severe ROP including APROP. Almost 7% severe ROP cases were outside screening guidelines of NNF. Late presentation for screening is the most important factor associated with ROP related blindness.

Comparitive Study Of Short-Term Outcomes Of Preterm Babies ≤30 Weeks In A Tertiary Care Hospital Between India And The U.K

“…Necrotising enterocolitis ≥stage 2 is 11.5% and 12.6% in U.K and Indian cohort, results are comparable to the previous studies [23].Number of babies with severe Retinopathy of Prematurity (ROP) and number of ROP needing treatment with laser or Avastin was signi cantly higher in Indian centre (12.9% vs 7.7%) despite higher gestational age of cohort than the UK centre possibly explained by difference in practices or higher risk factors. EPICure study [4] from the UK has shown an increased incidence of ROP needing treatment (Laser/Avastin) from 13% to 22%, however data from India for babies with ROP needing treatment (laser/Avastin) is between 16.6-20.7% [23,24]. Intraventricular haemorrhage grade 2 and above was 15.6% and 8.2% (p < 0.001) in U.K and India respectively which is slightly less than the previous studies [4,25].…”

“…From various previous studies we know that PDA treatment rates depend on the individual centres, treating neonatologist and many other factors [26] The proportion of mothers who received at least one complete course of antenatal steroids was 73.4% in the U.K cohort as compared to only 37.4% in Indian cohort. According to NNAP U.K 2016 data around 86% of eligible mothers received antenatal steroids [27] and in India there is wide variation in steroid uptake rate ranging from 48% to 74% [24,28] from previous studies . The low rate in Indian cohort perhaps presumed to be due to more high risk mother where there was not enough time to give antenatal steroid.…”

One-year Profile of Eye Diseases in Infants (PEDI) in secondary (rural) eye care centers in South India

“…The average proportion of ROP in neonatal intensive care units (NICU) based studies ranges from 2.3% to 30.1% in India. [ 13 14 ] These figures are an indirect indicator of the efficiency of the local healthcare system. The proportion of ROP among infants in our series is towards the lower range.…”

Screening and Management of Retinopathy of Prematurity

“…Preterm neonates being a heterogeneous group, baseline risk of ROP was divided into 2 categories based on incidence of ROP at different gestations reported in Indian studies: those at high risk (about one-third of screened need treatment, eg, neonates born at <32 weeks of gestation) and those at low risk of ROP (about 10% of screened need treatment, eg, neonates born at 32 to 36 weeks of gestation but are sick and are admitted in NICU/SNCU). 5, 8 - 11, 19 For every 1000 neonates screened (and treated if found eligible) versus not screened (and therefore not treated), there would be 219 fewer (95% CI: from 252 fewer to 175 fewer) cases of severe visual impairment in high-risk group neonates and 63 fewer (95% CI [72 fewer, 50 fewer]) cases of severe visual impairment in low-risk group neonates.…”

“…9 More recent reports of incidence of ROP in India are from newer or more “peripheral” hospitals and about neonates referred from district hospitals to tertiary care centers. 10, 11…”