Retinopathy of Prematurity in Port Harcourt, Nigeria

Abstract

Purpose. With many preterm babies now surviving as a result of improvement in neonatal care in Nigeria, the incidence of visual impairment/blindness as a result of retinopathy of prematurity (ROP) may rise. We describe our findings after screening starts for the first time in a 15-year-old special care baby unit so as to establish the incidence and risk factors for developing ROP. Methods. A prospective study carried out at the Special Care Baby Unit (SCBU) and Pediatric Outpatient Clinics of the University of Port Harcourt Teaching Hospital between January 1 and October 31, 2012. Fifty-three preterm babies (of 550 neonates admitted within the study period) delivered before 32 completed weeks and weighing less than 1500 g were included in the study following informed consent and the main outcome measure was the development of any stage of ROP. Results. Mean gestational age at birth was 28.98 ± 1.38 weeks. Mean birth weight was 1411 ± 128 g. Out of 550 babies admitted at SCBU, 87 of 100 preterms survived with 53 included in study. Twenty-five (47.2%) had different degrees of ROP with prevalence found to be 47.2%. Prevalence was higher (75%) in babies weighing <1300 g and those delivered before 30-week gestation (58%). Twenty-one (84%) had stage 1 no plus disease and 3 (12%) had stage 2 no plus disease. Only 1 (4%) had threshold disease in Zone 1. None had disease at stage 4 or 5 or AP-ROP. Receiving supplemental oxygen (χ 2 = 6.17; P = 0.01), presence of sepsis (χ 2 = 7.47; P = 0.006), multiple blood transfusions (χ 2 = 5.11; P = 0.02), and delivery by caesarian section (χ 2 = 4.22; P = 0.04) were significantly associated with development of ROP. There were no significant differences with gender, apneic spells, jaundice, or phototherapy. Conclusions and Relevance. All live infants with ROP were noted to regress spontaneously in this study. Though it may not be cost effective to acquire treatment facilities at the moment (the only child with treatable disease died), facilities for screening preterm infants displaying high risk features may be essential as smaller babies are saved.

Neonatal oxygen therapy in low- and middle-income countries: a pragmatic review

“…The publications in Africa were set in a tertiary care hospital and the main referral hospital in Malawi. 11,12,[15][16][17]21,[23][24][25][26] The publications from South Asia reflected studies conducted at tertiary care hospitals or neonatal intensive care units in India and Pakistan. 11,15,17,21,23,26 The only study from Western Pacific Region was conducted in five rural district hospitals in Papua New Guinea.…”

“…16 All other reports describing the use of pulse oximetry were not from publications specifically examining use in the population, but rather from publications evaluating the outcomes of oxygen therapy in selected centers or publications detailing the installation of new oxygen therapy equipment. 11,12,15,17,21,23,24,26 All of these publications indicated that pulse oximetry was available in the specified health facility in the course of the evaluation. 11,12,15,17,21,23,24,26 Only one publication reported information on neonatalspecific probes or the reuse or replacement of pulse oximetry probes.…”

“…11,12,15,17,21,23,24,26 All of these publications indicated that pulse oximetry was available in the specified health facility in the course of the evaluation. 11,12,15,17,21,23,24,26 Only one publication reported information on neonatalspecific probes or the reuse or replacement of pulse oximetry probes. Sa'avu et al, again reporting on five district hospitals in Papua New Guinea in a study published in 2014, found that none of the hospitals (0/5) had neonatal sensor probes for their pulse oximeters.…”

“…21 CLINICAL PRACTICE: MONITORING OF OXYGEN THERAPY Two publications provided information on goal oxygen saturation (SpO2) range used to guide oxygen therapy in neonates. 24,26 Adio et al, in a cohort study that screened premature neonates to determine the incidence and risk factors for the development of retinopathy of prematurity at a teaching hospital in Port Harcourt, Nigeria noted that neonates were treated with oxygen therapy at a goal range of 90-95% SpO2. 24 Likewise, Sathar et al, in a cohort study of retinopathy of prematurity development in premature neonates, described a goal SpO2 of 93-95% and indicated that monitoring with pulse oximetry was continuous.…”

Automatic Retinal Vessel Detection and Tortuosity Measurement

“…The focus in the evaluation on DR is usually on hard exudates, microaneurysms and vessel morphology. Retinopathy of prematurity (ROP) has also become a major cause of blindness to children in many middle income countries (O'Sullivan et al;Varughese et al;Chen et al;Gergely and Gerinec;2009;Hakeem et al;Adio et al;.…”