Retinopathy of prematurity: Risk factors and role of antenatal betamethasone in indian preterm newborn babies

Abstract

Background:Increase in the survival of preterm neonates has led to increased incidence of retinopathy of prematurity (ROP). Among various risk factors, only prematurity is well-established and role of others is still not clear. Effect of antenatal betamethasone on ROP severity is also controversial. Available literature from India has a paucity of information.Objectives:(a) The primary aim of the following study is to find the incidence and risk factors of ROP and (b) secondary aim is to assess the effect of antenatal betamethasone on ROP.Design:prospective, observational cohort study.Setting:Tertiary level neonatal care unit.Materials and Methods:A total of 148 infants ≤ 34 weeks gestation at birth, completed the study protocol. Severe ROP was defined as stage II and higher (including plus disease) of ROP. Various perinatal factors including antenatal betamethasone were analyzed by univariate followed by multivariate analysis.Results:overall incidence of ROP (any stage) was 44.6%. Severe ROP was mainly detected in <1200 g birth weight and/or <30 weeks gestational age. Antenatal betamethasone was associated with non-severe form of ROP (P < 0.05) on univariate analysis, but could not pass multivariate logistic regression analysis. Among other perinatal factors studied, low birth weight (<1200 g) (odds ratio [OR]: 19.699, 95% confidence interval [CI]: 2.42-160.17, P = 0.005), low gestational age (<30 weeks) (OR: 36.52, 95% CI: 3.76-354.3, P = 0.002), acidosis (OR: 6.932, 95% CI: 1.16-41.33, P = 0.034) and blood transfusion (OR: 14.11, 95% CI: 1.494-133.5, P = 0.021) were associated with babies in severe ROP in an independent manner.Conclusions:Low birth weight and low gestational age emerged as independent significant risk factors along with blood transfusion and acidosis. Antenatal betamethasone may be preventive for severe ROP. More studies are however recommended.

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

“…328 These results have been replicated in multiple subsequent studies, both for the risk of incident ROP and of treatment-requiring ROP. 6,10,11,13,14,17,18,21,47,57,65,75,77,94,102,109,114,122,125,135,138,143,147,152,157,174,202,204,216,228,231,233,236,240,246,255,263,266,271,276,282,283,285,308,311,312,315,335,337,348,362,367,371,373,378,391,398,405,406,410,412,418…”

“…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…”

A prospective observational study of retinopathy of prematurity in a tertiary care centre with respect to its incidence, risk factors and short term outcomes

“…Chawla et al 5 and Chaudhari 3 et al have used the same screening criteria. Screening criteria vary among institutes with respect to GA and birth weight [7][8][9][10][11][12][13][14] . The incidence of ROP in these studies from South India varied from 21.6% to 53.4% [7][8][9][10][11][12][13][14] .…”

“…Screening criteria vary among institutes with respect to GA and birth weight [7][8][9][10][11][12][13][14] . The incidence of ROP in these studies from South India varied from 21.6% to 53.4% [7][8][9][10][11][12][13][14] . The incidence of ROP globally varied from 11.8% to 68.0% 1,4,[15][16][17][18][19][20] .…”

The Effect of Volume Guarantee Ventilation on the Incidence of Retinopathy of Prematurity

“…ROP has different stages; stages 3 and 4 need immediate management decisions, but in lower stages, close follow-up is recommended (19,20).…”