Retinopathy of prematurity in neonatal care unit

Abstract

Background: The objectives of the study were to find the incidence of retinopathy of prematurity and risk factors associated with its development. Methods: Observational study was carried out at tertiary care hospital. Inclusion criteria: All hospitalized preterm infants with birth weight <1.5 Kg and gestational age ≤32 weeks. Selected preterm 1.5 to ≤2 Kg and gestational age >32 to ≤37 week, with additional risk factors (neonatal & maternal). Results: The overall incidence of ROP in present study was 21.87%. Of these 14.28% had stage І, 64.28% had stage ІІ ROP and 21.42% had plus disease. ROP was bilateral in all 14 neonates. The incidence was high in ELBW (100%), in the gestational age group 28-30 weeks (61.53%). Among the neonatal risk factors, oxygen therapy was a significant risk factor and chances of developing ROP were increased as duration of oxygen therapy increased (>72 hr) (p=0.0005). Episodes of hyperoxia, >3 episodes (p=0.0002) and hypoxia with 2-3 episodes, (p=0.008) were associated with development of ROP. Acidosis, (p=0.006), NEC (p=0.00002), proven sepsis (p=0.002), hyperbilirubinemia requiring intensive phototherapy (p=0.002), PDA (p=0.0007) and partial parenteral nutrition (p=0.02) were other risk factors associated. Mean NICU stay was longer in patients with ROP (p=0.001). Stage 1 and 2 ROP without plus disease showed spontaneous regression (100%) on follow up. Overall incidence of babies requiring laser treatment was 14.28%. Conclusions: We should screen all preterm with birth weight <1500 g and gestational age ≤32 weeks, irrespective of risk factors and babies between 1.5 to 2 kg and between 32 and 37 weeks, having risk factors for ROP.

Retinopathy of Prematurity: Incidence, Risk Factors & Outcome in North Indian Rural and Semi-urban population

“…RDS has been reported as a significant risk factor. 8,10,17 In the present study also about half the cases of RDS developed ROP. However, more significant in our study was a correlation that only 10% of those without RDS developed ROP.…”

“…But birth weight often corresponds to gestational age which makes it difficult to assess as an independent risk factor. Among babies with birth weight < 999 g, 80.8% developed ROP; risk gradually reduced to 4.5% in babies who had birth weight of 2000 g or more.While similar findings with reference to birth weight have also been reported, [8][9][10][11]15 it is difficult to compare studies. Inclusion criteria are often different, some centres had only selective age groups in their studies and at times differently classified weight groups of babies do not allow comparison between the studies.…”

“…In these babies, other risk factors were present which predisposed them to ROP. Various authors have also reported statistically significant correlation between supplemental oxygen and development of ROP 8,10,14,17 . More importantly, a negative correlation of baby not likely to develop ROP without oxygen supplementation in absence of other risk factors was significantly high.…”

“…Different studies in the past from Northern India have shown variable incidences like 11.9%, 21.87% and 44.6%. [7][8][9] Another study from Turkey found ROP in 32.1% cases. 10 Such variability is expected as developing of ROP depends on the survival rates of preterm neonates, the quality of neonatal care provided by the unit and level of ophthalmic assessment of the discharged neonates.…”

Retinopathy of prematurity: Risk factors and associated co-morbidities

“…4 It is emerging as one of the leading causes of preventable childhood blindness in India. 5 India accounts for the most preterm births in the world (3.5 million) 6 and has the thirdhighest incidence of L.B.W. being delivered every year, with about 1.7 million weighing <2500 g and about 0.4 million <1500 gm.…”