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Indian Pediatr 2015;52: 157-158 |
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Incidence and Risk Factors for Retinopathy of
Prematurity in Neonates
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*Mahuya Pal Chattopadhyay, Ashish Pradhan,
#Ritesh Singh and Sudip Datta
Departments of *Ophthalmology and Pediatrics, Sikkim
Manipal Institute of Medical Sciences, Gangtok, Sikkim; and #Community
Medicine, College of Medicine and JNM Hospital, The West Bengal
University of Health Sciences,
Kalyani, West Bengal, India.
Email: [email protected]
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We screened 50 neonates fulfilling
the inclusion criteria admitted during the study period in a teaching
hospital in a north-eastern state of India. Out of 50 neonates screened,
22 (44%) developed retinopathy of prematurity. There was significant
association between the birth weight and gestational age of the baby at
the time of the delivery with the development of ROP. Multivariate
analysis of risk factors for development of ROP using a stepwise method,
after controlling for various potential confounders, showed that apnea
was a significant risk factor for the development of retinopathy of
prematurity.
Keywords: Gestational age, Low birth
weight.
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The improved survival of preterm and small-for-date neonates in
developing countries has led to an increase in the incidence of
retinopathy of prematurity (ROP) in infants. The principal risk factors
for ROP are low gestational age, low birth weight and prolonged exposure
to supplementary oxygen therapy [1]; other risk factors include multiple
gestation, vaginal delivery, bronchopulmonary dysplasia and necrotizing
enterocolitis [2]. The most important determinant of any ROP management
program is an effective screening strategy [3].
The present study reports data from preterm and SFD
neonates admitted in the neonatal intensive care unit (NICU) of Central
Referral Hospitalin Sikkim, India during March 2007 to September 2009.
The inclusion criteria, based on. screening guidelines by Jalali, et
al. [4], were: neonates less than 1700 grams or 35 weeks gestational
age at birth and neonates 35 to 37 weeks or >1700 grams but less than
2000 grams with oxygen exposure for more than 30 days, respiratory
distress syndrome, sepsis, multiple births, multiple blood transfusions,
apnea, intraventricular haemorrhage, or if pediatrician had index of
suspicion of ROP A detailed history, including period of gestation, birth
weight and details regarding neonatal illnesses, and management were
recorded. The ROP screening of all neonates was done without anesthesia
in the NICU by a single experienced ophthalmologist. Follow-up
examination or treatment referral within 48 hours was recommended
following the ETROP guidelines [5]. All the findings of the examination
were documented according to the International Classification for
retinopathy of prematurity (ICROP)
recommendations specifying the location (Zone I–III) and
severity of the disease (Stage I-V) with or without plus component and
the extent of clock hours [6].
During the study period, 50 eligible neonates were
screened for ROP. The birth weight of the neonates ranged from 1000 to
2620 g with a mean (SD) of 1639 (44.8) gTwenty-two (44%) developed
retinopathy of prematurity; 8 and 6 had stage 1,2, and 3 ROP,
respectively. Zone involved were 1, 2 and 3 in 2,12 and 8 children,
respectively. 10 had plus disease. The mean (SD) birth weight and
gestational age of the neonates with and without ROP were 1410 (350)
gand 31.8 (2.1) weeks; and 1820 (440) gand 32.9 (2.1) weeks,
respectively. In univariate analysis, spontaneous vaginal delivery,
non-administration of antenatal steroids to mothers and apnea were
associated with the development of ROP. Multivariate analysis using a
stepwise method, after controlling for various potential confounders,
showed that apnea was the only significant risk factor for the
development of retinopathy of prematurity.
The proportion of children developing ROP in the
present study is very similar to that reported at other centers [7,8].
The beneficial effect of antenatal steroids has also been documented
earlier [9].
References
1. Akkoyun I, Oto S, Yilmaz G, Gurakan B, Tarcan A,
Anuk D, et al. Risk factors in the development of mild and severe
retinopathy of prematurity. J AAPOS. 2006;10:449-53.
2. Abdel HA, Hakeem A, Mohamed GB, Othman MF.
Retinopathy of Prematurity: A study of prevalence and risk factors.
Middle East Afr J Ophthalmol. 2012;19:289-94.
3. Vedantham V. Retinopathy of prematurity screening
in the Indian population: it’s time to set our own guidelines. Indian J
Ophthalmol. 2007;55:329-30.
4. Jalali S, Anand R, Kumar H, Dogra MR, Azad R,
Gopal L. Programme planning and screening strategy in retinopathy of
prematurity. Indian J Ophthalmol. 2003;51:89-97.
5. Good WV. Early treatment for retinopathy of
prematurity cooperative group. Final results of the early treatment for
retinopathy of prematurity (etrop) randomized trial. Am Ophthalmol Soc.
2004;102:233-50.
6. International Committee for the Classification of
Retinopathy of Prematurity. The International Classification of
Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123:991-9.
7. Yau GS, Lee JW, Tam VT, Liu CC, Chu BC, Yuen CY.
Incidence and risk factors for retinopathy of prematurity in extreme low
birth weight Chinese infants. Int Ophthalmol. 2014 Jun 5. [Epub ahead
of print].
8. Uchida A, Miwa M, Shinoda H, Koto T, Nagai N,
Mochimaru H, et al. Association of maternal age to development
and progression of retinopathy of prematurity in infants of gestational
age under 33 weeks. Journal of Ophthalmology; Volume 2014;2014:187929..
9. Maini B, Chellani H, Arya S, Guliani BP.
Retinopathy of prematurity: Risk factors and role of antenatal
betamethasone in Indian preterm newborn babies. J Clin Neonatol.
2014;3:20-4.
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