Background Retinopathy of prematurity (ROP) is a potentially vision threatening disease affecting preterm babies. Progress in neonatal intensive care in recent years has led to an increased survival of preterm & sick babies and subsequently, to an increasing incidence of ROP.
Objectives To analyze the incidence, risk factors and outcome of ROP.
STUDY POPULATION 50 Babies ≤32 weeks gestational age and 50 preterm babies >32 weeks gestational age.
INCLUSION CRITERIA Babies with birth weight ≤1500 g. Babies born at ≤32 weeks of gestation. Selected preterm babies with a birth weight between 1500 grams and 2000 grams or gestational age of more than 32 weeks with additional risk factors (eg. oxygen therapy, sepsis, apnea, birth asphyxia, RDS, NEC, use of surfactant, exchange transfusion, IVH, PRBC transfusion).
Group1: Babies with gestation ≤32 weeks and/or babies with birth weight ≤1500 g.
Group2: Selected preterm babies with a birth weight between 1500 grams and 2000 grams or gestational age of more than 32 weeks with additional risk factors as mentioned above
EXCLUSION CRITERIA Outborn babies treated in our NICU
STUDY PERIOD: 2017- 2018 When to screen: First screening examination should be carried out at 31 weeks of gestation or 4 weeks of age, whichever is later.
All the babies found to have ROP were regularly followed up in both our high risk clinic and in Ophthalmology outpatient department for one year.
Results Incidence of ROP was 23% in our study. Incidence was 38% in the 1 st group & 8% in the 2 nd group.
Most common findings were stage III ROP (39%) and zone II ROP (70%). 3 (13%) had APROP (Aggressive posterior ROP) and 2 (8.7%) had retinal detachment.
The incidence of ROP increased as the birth weight and period of gestation decreased- no ROP was found in gestation ≥35 weeks and birth weight >1.828 kg.
In our study, oxygen administration through mechanical ventilator or CPAP, sepsis, therapy with surfactant, apnea, PRBC transfusion, NEC and birth asphyxia were found to be significant risk factors. The risk of ROP is more in RDS, IVH and only head box oxygenation but the risk is not significant. We have not found any ROP in the babies who have undergone exchange transfusion.
13 (57%) babies had spontaneous regression of ROP and rest 10 (43%) required some intervention. To summarize the intervention (n=10), 5 (50%) responded to LASER only, 3 (30%) required intravitreal injection with Bevacizumab (anti-VEGF) following LASER, 1 (10%) required TPPV (Trans Pars Plana Vitrectomy) in left eye for ROP stage IVb along with LASER and 1 (10%) baby required all the three- LASER, intravitreal Bevacizumab and left sided TPPV.
Conclusions Thus the need for a routine screening program for the detection of ROP in preterm and sick neonates with risk factors is very essential in our clinical settings. Prevention of blindness from ROP can be very effective through early detection and urgent treatment. This needs awareness among neonatologists and pediatricians for referral to the ophthalmologists at appropriate age of the baby.
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