Retinopathy of prematurity in Kenya: prevalence and risk factors in a hospital with advanced neonatal care

Global Prevalence and Severity of Retinopathy of Prematurity over the Last Four Decades (1985-2021): A Systematic Review and Meta-Analysis

BACKGROUND

Retinopathy of prematurity (ROP) is a vasoproliferative disease of the retina that occurs in premature infants. The prevalence of ROP reported so far is inconsistent.

AIM

To conduct a systematic review to describe the trend of ROP prevalence between 1985 and 2021, and to determine the influence of countries' economic conditions on ROP prevalence.

METHODS

We searched PubMed, Embase, and Google Scholar for studies published between January 1985 and December 2021 using the following MeSH terms: "retinopathy of prematurity", "ROP", "incidence", and "prevalence". Two independent reviewers examined the articles to select studies that met the selection criteria and performed data extraction and study quality assessment. For the meta-analysis, the pooled prevalence was calculated using a random-effects model and R software.

RESULTS

Of 5,250 titles and abstracts, 139 original studies met the inclusion criteria; a total of 121,618 premature infants were included in these studies. The pooled prevalence of ROP was 31.9% (95% confidence interval [CI] 29.0-34.8) and that of severe ROP was 7.5% (6.5-8.7). In general, no significant differences in prevalence were found over the four decades; however, we found a higher prevalence in premature infants ≤28 weeks of gestational age. In addition, the highest ROP prevalence was found in lower-middle-income countries with high mortality rates. In contrast, the highest severe ROP prevalence was found in high-income countries.

CONCLUSION

ROP remains a common cause of morbidity in premature infants worldwide. Therefore, it seems necessary to maintain early identification strategies for patients at higher risk, particularly in low- and middle-income countries.

Prevalence and pattern of retinopathy of prematurity at two national referral hospitals in Uganda: a cross-sectional study

BACKGROUND

Retinopathy of prematurity (ROP) is a leading cause of blindness in children and an ROP epidemic is predicted this decade in sub-Saharan Africa. With the increasing survival rate of preterm babies in Uganda, and no data on ROP prevalence, there is a need to assess the burden of ROP to inform preventive strategies and targeted screening.

METHODS

We conducted a two-center cross-sectional study of preterm (< 37 weeks gestational age) infants from the neonatal units of Kawempe National Referral Hospital (KNRH) and Mulago Specialised Women and Neonatal Hospital (MSWNH) from August 2022 to October 2022. An ophthalmologist examined all participants using an indirect ophthalmoscope with a + 20D convex lens and captured digital images using a Volk iNview™ Fundus Camera. The collected data were entered into Epidata 4.2 and exported to Stata 14.0 for analysis.

RESULTS

331 preterm infants enrolled in this study. The oxygen received was unblended. The mean gestational age was 30.4 ± 2.7 weeks, and the mean birth weight was 1597 ± 509 g. 18/101 (17.8%) were found to have any ROP amongst the preterm infants recruited from MSWNH, 1/230 (0.4%) from KNRH [95% CI] had any stage of ROP (i.e. stage 5). Of these, 8 (42.1%) had stage 2 ROP. Infants with a birth weight below 1500 g were 10 times more likely to have ROP than those among infants with a birth weight more than 1500 g [AOR: 10.07 (2.71-37.44)]. Infants who were not fed exclusively on breast milk had higher odds of having ROP than those exclusively fed on breast milk [AOR: 7.82(1.92-31.82)].

CONCLUSION

6% of preterm infants born in two tertiary hospitals in Uganda were found to have ROP. Lack of exclusive feeding on breast milk and birth weight of less than 1500 g were strong predictors of ROP. The higher prevalence of ROP in MSWNH calls for cautious use of oxygen among preterms. We recommend targeted ROP screening for those at risk.

Effect of mode of delivery on perinatal outcome in severe preterm birth: systematic review and meta-analysis

OBJECTIVE

To review the evidence on the effect of mode of delivery on perinatal outcome of fetuses born before 32 weeks' gestation.

METHODS

MEDLINE, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), the ClinicalTrials.gov registry and gray literature sources were searched, starting from the year 2000 to reflect contemporary practice in perinatal care. Non-randomized or randomized studies that included singleton fetuses without chromosomal abnormality or major congenital defect delivered vaginally or via Cesarean section were eligible for inclusion in the analysis. Primary outcomes were neonatal death, defined as death in the first 28 days of age, and survival to discharge. Secondary outcomes were other adverse perinatal events. The ROBINS-I tool was used to assess the risk of bias. The overall quality of evidence for the outcomes was assessed according to GRADE. Summary odds ratios (ORs) with 95% CIs were calculated, and random-effects models were used for data synthesis. Subgroup analysis was performed for delivery before 28 weeks, delivery between 28 and 32 weeks and according to fetal presentation at delivery.

RESULTS

A total of 27 retrospective studies (22 887 neonates) were included in the systematic review and meta-analysis, all of which reported on singleton pregnancies. Among cases born before 28 weeks, vaginal delivery significantly increased the risk of neonatal death of fetuses with any type of presentation (n = 1496) (OR 1.87 (95% CI, 1.05-3.35); I2  = 65%, very low quality of evidence) and of fetuses with breech presentation (n = 733) (OR 3.55 (95% CI, 2.42-5.21); I2  = 21%, moderate quality of evidence). The odds of survival to discharge were significantly decreased among fetuses with breech presentation delivered before 28 weeks (n = 646) (OR 0.36 (95% CI, 0.24-0.54); I2  = 21%, low quality of evidence). Among breech fetuses born between 28 and 32 weeks, vaginal delivery increased the odds of perinatal death (intrapartum and neonatal) (n = 1581) (OR 3.06 (95% CI, 1.47-6.35); I2  = 0%, high quality of evidence). In non-cephalic fetuses born between 24 and 32 weeks, vaginal delivery decreased the odds of survival to discharge (n = 1030) (OR 0.28 (95% CI, 0.19-0.40); I2  = 0%, moderate quality of evidence). No significant effect on mortality of mode of delivery was observed in cephalic fetuses at any gestational age.

CONCLUSIONS

This systematic review and meta-analysis suggests that vaginal delivery in severe preterm birth is associated with an increased risk of neonatal and perinatal death in breech fetuses, while no significant association was observed for cephalic fetuses. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Association between severe retinopathy of prematurity (ROP) and poor motor neurodevelopmental outcome

During the final (third) trimester outside of the womb, the retina develops significantly and is vulnerable to problems. Similar to how the cerebral cortex does, the cerebellum also grows quickly during this time and is susceptible to upsetting environmental influences. The only factors that show promise for lowering the incidence and retinopathy of prematurity (ROP) severity among high-risk infants are prematurity prevention, preeclampsia control, and prudent use of oxygen therapy and ventilation. The third trimester is when the cerebral cortex, cerebellum, and retina develop. These areas are vulnerable to environmental influences if their development is interrupted. Throughout childhood and adolescence, neurodevelopmental defects have been linked to impaired cortical development and smaller brain volumes. Reduced cerebellar volumes have been linked to an increased risk of autism spectrum disorder, lower motor performance, impaired executive functioning, and poorer cognitive outcomes. The complete avascular retina, as well as the peripheral retina, should be treated during retinal ablation with laser photocoagulation (using a transpupillary diode, 11 argon, and three FD-YAG) or cryoablation as failing to do so promotes disease progression and results in unfavorable anatomical and refractive outcomes.

A Review on the Incidence and Related Risk Factors of Retinopathy of Prematurity Across Various Countries

Retinopathy of prematurity (ROP) is an ophthalmologic condition that is one of the leading causes of preventable childhood blindness. Due to the premature nature of blood vessels in preterm infants, retinal vessels are prone to damage. The incidence of ROP ranges with great variation across countries, and this study aims to identify the incidence and its related risk factors. A compilation of studies investigating the incidence of ROP was acquired through the PubMed and Google Scholar databases with a full free text in English filter set. All members of the study were involved in designating studies based on continent and arranging them into a table format. Following this, reasons for the variation in the incidence of ROP were investigated by individually assessing each study. The variation of an increased incidence of ROP seen in low-income countries (LICs) was most likely due to the availability of resources. As a preterm birth can give rise to further complications such as the development of sepsis, it is important to manage preterm birth with the utmost caution. Evidence has suggested that the two key variables in reducing the morbidity and mortality of ROP are the implementation of a screening and treatment protocol with controlled use of oxygen and the availability of resources in hospitals to adequately identify and manage ROP as early as possible. Through a comprehensive overview of the incidence of ROP, it is vital to review screening and treatment protocols in each hospital for ROP, which would aid in preventing its occurrence and initiating early treatment.

Effects of Early Treatment of Retinopathy of Prematurity at a Tertiary Care Hospital in Saudi Arabia: A Retrospective Study

PURPOSE

To estimate the prevalence of retinopathy of prematurity (ROP) among high-risk neonates and to illuminate the benefits of early treatment in type 2 ROP (zone II, stage 3 without plus) and ROP milder than type 1 with pre-plus disease (zone III, stage 3).

METHODS

This retrospective cross-sectional study was conducted among 307 high-risk neonates (614 eyes) with a gestational age of 32 weeks or younger at birth and a birth weight of 1,500 g or less, from 2011 to 2016. Treatment was initiated for neonates with low-risk type 2 ROP and ROP milder than type 1 with pre-plus disease, whenever retinopathy was evident for 3 clock hours with or without vitreous hemorrhage. Post-treatment progression was recorded.

RESULTS

The prevalence of ROP in the current study was 33.71%. Two hundred seven eyes had ROP; 47.34% had mild retinopathy that did not require treatment, and 52.66% received laser treatment, including the early treated group. Of the 207 eyes with ROP, 46.86% had low-risk type 2 ROP disease and ROP milder than type 1 with pre-plus disease, and underwent photocoagulation therapy. After treatment, 15.38% and 10.71% eyes were stable, 84.62% and 88.10% eyes had regressed retinopathy, and 0% and 1.19% progressed in both groups, respectively.

CONCLUSIONS

Early treatment of type 2 ROP and ROP milder than type 1 with pre-plus disease in certain cases significantly decreased the rate of progression to more advanced stages and resulted in good clinical outcomes. [J Pediatr Ophthalmol Strabismus. 2021;58(4):240-245.].

Incidence and risk factors of retinopathy of prematurity in Korle-Bu Teaching Hospital: a baseline prospective study

OBJECTIVE

To determine the incidence of retinopathy of prematurity (ROP) and any associated risk factors among preterm infants at the Neonatal Intensive Care Unit (NICU) of Korle-Bu Teaching Hospital (KBTH).

DESIGN

Prospective study.

SETTING

Level 3 NICU of KBTH from June 2018 to February 2019.

PARTICIPANTS

Eligible infants with birth weight (BW) less than 2 kg or gestational age (GA) less than 37 weeks were examined at scheduled intervals until full maturity of their retina.

OUTCOME MEASURES

The primary outcome measure was cumulative incidence of ROP and secondary outcome measure was risk factors associated with ROP.

RESULTS

Of the 401 infants, 222 were females (55.4%), mean±SD GA was 32.3±2.4 weeks (median 32, IQR 31 to 34) and mean BW 1.6±0.4 kg (median 1.5, IQR 1.3 to 1.9). The cumulative incidence of ROP was 13.7% (95% CI: 10.5 to 17.5%), with 1.8% (seven infants) having type 1 ROP. Increased risk of ROP was observed in babies with supplemental oxygen exposure (p<0.001), BW less than 1.5 kg (p=0.019), confirmed neonatal sepsis (p=0.001), nasogastric tube feeding (p=0.03) and poor pupillary dilation (0.032). A reduced risk of ROP was observed in boys (p=0.004) and after delivery by caesarean section (p=0.019).

CONCLUSION

The rates of ROP at KBTH are comparable to other NICUs in sub-Saharan Africa. Birth weight less than 1.5 kg, confirmed neonatal sepsis, nasogastric tube feeding and poor pupil dilation were independently associated with increased incidence of ROP. ROP screening should be a part of the routine service for premature infants in Ghana.

Incidence and Risk Factors for Retinopathy of Prematurity in Tabuk City, KSA

PURPOSE

Retinopathy of prematurity (ROP) is becoming a leading cause of preventable blindness. The current study aimed to assess ROP and its risk factors in Tabuk City, Northern Kingdom of Saudi Arabia.

METHODS

A retrospective study was conducted in King Khalid Hospital, Tabuk City, Saudi Arabia. The premature infants' records during the period of January 2016 to April 2018 were approached. One hundred and eight records were eligible; the infants' gestational age, weight, if received oxygen, surfactant use, blood transfusion, intraventricular hemorrhage, and patent ductus arteriosus were reported. Chi-square test was used to compare premature infants and their counterparts regarding various risk factors. P < 0.05 was considered statistically significant.

RESULTS

Out of 108 premature infants, 33.3% had ROP (Many were sightthreatening [stages required treatment] and more than twothirds involving both eyes); a statistically significant difference (P < 0.05) was evident between infants with prematurity, and low birth weight. No significant differences were found regarding other risk factors (P > 0.05). Only 8.3% received interventional therapy.

CONCLUSION

ROP is common in King Khalid Hospital, which is the referral tertiary hospital in Tabuk city, KSA . The low birth weight is a significant risk factor to develop ROP. Many of ROP cases were sightthreatening (cases that required treatment) and most cases involving both eyes. Treatment availability at Tabuk city is recommended, instead of referral to another centers especially among those with low weight at birth.

Profile, Visual Presentation and Burden of Retinal Diseases Seen in Ophthalmic Clinics in Sub-Saharan Africa

Purpose

To determine the burden of retinal diseases and the degree of visual impairment associated with each disease, amongst Nigerians.

Patients and Methods

This was a hospital-based multicenter, prospective, cross-sectional, non-comparative study conducted from January to December 2018. Data was obtained from consecutive patients with a retinal diagnosis presenting at the general ophthalmic and specialty retina clinics in four hospitals (three public, and one private teaching eye department) in Nigeria. Biodata, visual acuity and refraction, intraocular pressure, findings on dilated retinal examination, diagnosis and systemic diseases were noted. Degree of monocular and bilateral visual loss associated with each diagnosed retinal disease was summarized and p value was calculated using chi-square test. P < 0.05 was considered significant.

Results

Eight hundred seventy-six of 8614 patients had a retinal diagnosis; establishing a hospital-based retinal disease prevalence of 9.8%. Male:female ratio was 1.1:1. The mean age of study patients was 49.97 (standard deviation 17.64 years). Mean symptom duration was 21.63 months (standard deviation 41.94). The mean intraocular pressure was 13.87 mmHg. Forty-three different retinal diseases were diagnosed. The most common was retinal complications of diabetes, i.e., diabetic retinopathy (DR) alone, diabetic macular edema (DME) alone and a combination of DR and DME, which accounted for 13.7%, 5.6% and 9.3%, respectively (contributed 28.6% of the entire diagnosis). This was followed by retinal detachment (RD), in 219 eyes (15.4%), dry age-related macular degeneration (AMD) in 124 eyes (8.7%). Nearly half of the eyes were blind or severely visually impaired. Blindness occurred in 34.1% of eyes; severe visual impairment in 8.2% of eyes and 29.7% had normal vision. There were 469 patients who had systemic diseases. The common systemic diseases were hypertension in 169 patients (19.3% of the total number of patients), hypertension and diabetes in 156 patients (18%), and diabetes alone in 98 patients (11.1%). Sickle cell disease was present in 1.5%.

Conclusion

There is need to invest in infrastructure, local training and development of systems for early detection and treatment of several retinal diseases in sub-Saharan Africa; DR and DME having the largest burden. Collaborative physician care and management of hypertension and diabetes could significantly reduce the burden of DR and DME.

Retinopathy of prematurity in Africa: a systematic review

Purpose: Retinopathy of prematurity (ROP) is widely regarded worldwide as a major cause of childhood blindness, however until recently the disease has not been recognized in most of the African continent. As a result of changing economic conditions, there is growing evidence that the population at risk for ROP in Africa is increasing. This report aims to summarize the published literature on ROP from Africa. Methods: We performed a systematic literature review of the English and French online literature databases by applying a general search strategy initially on May 1, 2017 with repeat inquiry on May 20, 2018. Search phrases included multiple variants of terms including "ROP", "retinopathy of prematurity", in conjunction with each of the individual 54 recognized sovereign African states. Findings: A total of 25 individual studies from six African nations were identified: South Africa (10), Egypt (7), Nigeria (4), with the nations of Sudan, Rwanda, and Kenya each having one respective study. Two countries (South Africa and Kenya) have developed national ROP policies for primary and secondary prevention. Summary: Review of the published literature suggests that ROP is emerging in Africa, however, there are published data from 6/54 (11%) African nations. Blindness from ROP is often preventable with appropriate primary and secondary prevention. This report provides compelling evidence that these efforts should be undertaken to implement and evaluate regionally appropriate ROP prevention programs in a growing number of African countries.

The treatment and risk factors of retinopathy of prematurity in neonatal intensive care units

Background

Retinopathy of prematurity (ROP) is a vascular proliferative disorder of the developing retina and a significant cause of childhood blindness around the world. The incidence of ROP is affected by many factors, and the incidence rate varies from country to country. The purpose of this study is to report the incidence and risk factors of ROP in neonatal intensive care unit (NICU) of Guangzhou First People’s Hospital in China.

Methods

A retrospective review was performed on 436 premature infants who were consecutive ROP screened in the NICU of Guangzhou First People’s Hospital from March 2013 to October 2017. The single-factor analysis and the logistic multivariate regression analysis were used to detect risk factors of ROP.

Results

Total 436 premature infants were consecutive ROP screened, 138 (31.65%) were found ROP, and 61(13.99%) were treated. The single-factor analysis revealed that the incidence of ROP was associated with multiple births, gestational age, birth weight, mechanical ventilation, intravascular hemolysis, the number of operations and blood culture results. The logistic multivariate regression analysis revealed that gestational age; birth weight, mechanical ventilation, minimum SaO2 and daily weight gain were independent risk factors for ROP onset. Forty-nine patients underwent retinal laser photocoagulation with recurrence 20 patients. Twelve patients underwent anti-VEGF drug (Ranibizumab) via intraocular injection with 5 patients of recurrence.

Conclusions

The incidence of ROP in NICU of Guangzhou China will match those in middle-income countries, but higher than high-income countries. Anti-VEGF drugs could be preferred as a good treatment method for zone 1 ROP and aggressive posterior ROP.