Retinopathy of prematurity in a cohort of neonates at Groote Schuur Hospital, Cape Town, South Africa

Abstract

Background. Severe retinopathy of prematurity (ROP) can cause blindness. Before 2016, resource limitations precluded routine screening for ROP at Groote Schuur Hospital (GSH), Cape Town, South Africa. Previous pilot studies at GSH found no patients with ROP requiring treatment; however, improved preterm infant survival may affect the prevalence. Objectives. To determine the prevalence and severity of ROP, describe potential risk factors, and assess the feasibility of ROP screening. Methods. Infants with a birth weight (BW) of <1 251 g or a gestational age (GA) of ≤31 weeks were screened from November 2012 to May 2013. Results. Three hundred and thirteen ROP examinations were performed in 135 of 191 eligible infants. The mean GA and BW were 30.1 weeks (standard deviation (SD) 1.9) and 1 056 g (SD 172), respectively. ROP was diagnosed in 40 infants (29.6%); 8 (5.9%) had severe ROP and 2 (1.5%) received laser treatment. Infants with ROP had a lower mean GA (29.2 weeks (SD 1.6) v. 30.5 weeks (SD 1.9)) (p<0.002) and a lower mean BW (988 g (SD 181) v. 1 085 g (SD 160)) (p=0.001) than those without ROP. Infants weighing <1 000 g had a 2.5 times higher risk than those with a BW of ≥1 000 g of having ROP (95% confidence interval 1. 05 -5.90; p=0.03). Blood transfusions (p<0.002) and late-onset sepsis (p=0.024) were strongly associated with ROP. Screening was completed in 91.1% (123/135) of the infants. Conclusions. The prevalence and severity of ROP have increased at GSH. The strong association between ROP, BW and GA suggests that infants with lower BWs and GAs should be prioritised for screening in our resource-limited setting.

Analysis of a Two-Year Independent Screening Effort for Retinopathy of Prematurity in Rural Egypt

“…The incidence of ROP in our sample (48.19%) is higher than rates reported in studies from other middle income countries like India (Eastern India 33.2% [22], Northern India 26.6% [23], and rural outreach centers 22.39% [24]), Turkey (30% [25] and 27% [26]), South Africa (29.6% [27]), Iran (23.5% [28]), Palestine (23.5% [29]), and Botswana (11% [30]). The incidence of AP-ROP (8.7%) is also beyond the high end of the spectrum of rates reported in the literature that range from 0.11-5% [6].…”

Retinopathy of prematurity: a review of risk factors and their clinical significance

“…Transfusion of RBCs appears to be a risk factor for the development of ROP. 5,11,20,39,40,65,82,86,101,102,106,116,122,123,137,143,148,150,152,167,180,202,207,208,220,229,246,257,283,315,334,346,348,356,367,389,414 Four randomized controlled trials and a meta-analysis on the effect of transfusion protocols suggest the amount of transfusion may not be associated with ROP. 42,56,72,112,214…”

“…Neonatal sepsis is among the most frequently identified risk factors for any ROP and severe ROP. 5,10,14,23,35,57,65,68,114,137,143,149,150,152,205,208,220,229,235,245,249,257,263,264,266,271,277,283,301,309,315,362,367,377,391,414,423 It has been suggested that perinatal infection and inflammation may play important roles in ROP. 91 A New York state cohort study reported that the presence of neonatal sepsis was associated with an elevated risk of ROP.…”

Análisis de la frecuencia y factores de riesgo asociados a la retinopatía del prematuro en neonatos de muy bajo peso al nacer

“…En este estudio, la retinopatía en general se presentó en el 53.9% de los casos, lo cual concuerda con los resultados de otros países con ingresos medios 33 . Sin embargo, los resultados de diversos países de la Red Internacional para la Evaluación de los Resultados de los recién nacidos indican tasas del 25.2 al 91% para cualquier ROP, en un total de 48,087 lactantes de 24-27 SDG incluidos en el análisis 34 .…”

“…En cambio, en el estudio de Guadalajara, el porcentaje aumenta al 30.3% si se analizan únicamente los casos de retinopatía. En general, diversos resultados refieren una media del 50% y un estadio 3 del 1.5 al 14% para todas las ROP 7,8,[32][33][34][38][39][40] .…”