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research letter

Indian Pediatr 2015;52: 157-158

Incidence and Risk Factors for Retinopathy of Prematurity in Neonates

 

*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]
 

 

 

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.



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

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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.

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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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