Incidence Of Retinopathy Of Prematurity Among Premature Babies Born At A Tertiary Care Hospital - A Longitudinal Study With A Short Follow Up

Abstract

Background: Retinopathy of prematurity ( ROP ) is a common blinding disease in children in the developed world despite current treatment, and is becoming increasingly prevalent in the developing world. Improved survival of preterm neonates has increased the incidence of retinopathy of prematurity ( ROP ) in India. Objective: To know the incidence of ROP in preterm infants with birth weight ≤ 1500 grams and/or gestational age ≤32 weeks and to correlate b etween development of ROP and the risk factors. Methods: A longitudinal study of 100 infants weighing ≤1,500 gms and/or GA ≤32 weeks at birth was conducted. The main clinical outcomes were the incidence of any stage of ROP and severe ROP. The variables considered for the study were: birth weight, gestational age, gender, oxygen, multiple gestations, occurrence of sepsis, respiratory distress syndrome, transfusion, apnoea, PIH, hypotension, fetal distress, anaemia and metabolic acidosis. Results: The incidence of ROP in this study was found to be 16%. 18.75% babies were in stage 1, 68.75% were in stage 2 and 6.25% was in stage3 ROP. Only 6.25% developed APROP. The mean birth weight of the ROP babies was 1272.81 ± 143.67 gm, while that of non-ROP babies was 1642.80 ± 216.60 gm. Lower birth weight was significantly associated with increased incidence ( p = <0.001) of ROP. The incidence of ROP was 40% in babies weighing ≤ 1500gm at birth. v The mean gestational age of the ROP babies was 31.38 ±1.63 weeks, while that of non-ROP babies was 33.31 ± 1.74 weeks. The incidence of ROP was 26.32% in babies born ≤ 32 weeks of gestational age. Gestational age was found to be a significant risk factor for the development of ROP ( p=0.004) . On Univariate analysis, risk factors associated with ROP were Oxygen, RDS &Transfusion ( FFP/Platelet ) . On Multivariate analysis, RDS was found to be an important risk factor. Using the forward method, Oxygen and Transfusion were also found to be significant on Multivariate analysis. Conclusion: The present study reflects the problem of ROP in a tertiary care centre. Early examination was significantly associated with chances of early detection of ROP ( p = 0.016) and hence all babies should have their first screening within the first four weeks after birth. In our opinion, the effective management of ROP requires a team effort of the neonatologist, ophthalmologist and the NICU staff. Regular screening programme with a criteria of birth weight <1500 gms and gestational age <32 weeks or both and babies more than 1500 gms and >32 weeks with other risk factors should be screened at the discretion of the neonatologist and ophthalmologist. Along with regular screening, an effective control of oxygen delivery, reduction of apneic spells and their early recognition and effective management of RDS are required