Adopting Western Retinopathy of Prematurity Screening Programs in Eastern Countries, are we Screening Properly?

Retinopathy of prematurity in Ardabil, North West of Iran: Prevalence and risk factors

Retinopathy of prematurity (ROP), which affects the retina of premature infants, is a leading cause of blindness in premature infants worldwide. The aim of this study was to evaluate the frequency and risk factors of retinopathy of prematurity infants referred to Alavi hospital between October 2018 and October 2019. In the present study, 400 infants with gestational age less than 34 weeks and or birth weight of 2000 g or less were enrolled in the study. Required information including sex, gestational age, maternal age, birth weight, type of delivery, oxygen therapy, septicemia, multiple gestations, consanguineous marriage, respiratory problem, and blood exchange were extracted from their hospital records and then included in the data collection form. These infants were also examined for ROP, stage and area of involvement by an experienced ophthalmologist and then classified into two groups including retinopathy and healthy group. Finally, the data were analyzed in SPSS 25 software using chi-square, fisher exact test, t-test, binary logistic regression, and ROC curve analysis. Of the 400 preterm infants studied (57.2% male and 42.8% female), 107 (26.8%) infants had ROP of whom 23 (21.5%) needed treatment (i.e. 5.8% of all infants need treatment). There were 4 (3.7%), 29 (27.1%), and 74 (69.2%) infants with zone I, II, and III, respectively. There were 91 (85%), 11 (10.3%), and 5 (4.7%) infants with stage I, II, and III, respectively. Multivariate logistic regression analysis showed that parental consanguinity (OR=2.263, 95%CI: 1.240-4.130, P=0.008), gestational age less than 32.5 weeks (OR=4.067, 95%CI: 2.340-7.069, P<0.001), and birth weight less than 1725 g (OR=4.522, 95%CI: 2.677-7.637, P<0.001) were associated with a 2.3-fold, 4.1-fold, and 4.5-fold increased risk of ROP, respectively. ROP had no significant relationship with other variables. In summary, the findings of the present study showed that one quarter of the premature infants had ROP. Furthermore, birth weight less than 1725 g, gestational age less than 32.5 weeks, and parental consanguinity were risk factors for ROP, in addition, one-fifth of the infants with ROP needed treatment.

Retinopathy prematurity: a systematic review and meta-analysis study based on neonatal and maternal risk factors

BACKGROUND

Retinopathy of prematurity is the abnormal development of retinal arteries in preterm neonates less than 32 weeks and weighing 1500 g, and less, which can lead to visual impairment during life and blindness. This study aims to investigate the relationship between some clinical characteristics of neonates and mothers with Retinopathy of prematurity in the world via a systematic review and meta-analysis.

MATERIALS AND METHODS

The present study is a systematic review and meta-analysis on the relationship between maternal and neonatal clinical variables with Retinopathy of prematurity in the world from the beginning of 2000 to the end of 2020. Accordingly, all English articles published on the topic were searched in scientific databases of Web of Science, PubMed, Google Scholar, Science Direct, and Scopus. The articles were searched independently by two researchers. Statistical analysis of data was performed using fixed and random effects model statistical tests in the meta-analysis, Cochran, meta-regression, I² index, Funnel plot, and Begg's by STATA software program, version 14.

RESULT

A total of 191 studies with a sample size of 140,921 persons were including in the meta-analysis. Accordingly, Preterm delivery ≤28 weeks (OR:6.3, 95% CI:4.9-8.1), Birth Weight ≤1000 g (OR:5.8, 95% CI:4.8-6.8), Birth Weight ≤1500 g (OR:4.8, 95% CI:3.8-6.1), PROM (OR:1.2, 95% CI:1.0-1.4), induced fertility (OR:1.9, 95% CI:1.1-3.0) and Chorioamnionitis (OR:1.5, 95% CI:1.0-2.2) There was a statistically significant association with retinopathy.

CONCLUSION

Based on the results of the present meta-analysis, the risk of retinopathy of prematurity in neonates born at 28 weeks and less, LBW (weight 1500 g and less), neonatal hypotension, chorioamnionitis, and induced fertility increases.

Knowledge of and attitude to eye disorders among pediatricians in North Jordan

PURPOSE

To assess the general knowledge of and attitude to various common eye conditions in children among pediatricians in north Jordan.

METHODS

This was a descriptive cross-sectional study. An exploratory questionnaire was developed by the research team to collect the necessary qualitative information.

RESULTS

In total, 48 pediatricians participated in the study. Around two-thirds performed eye examinations in children; however, only 10.4% (n = 5) carried out eye exams routinely as part of every child's health visit. The most common test done was assessment of red reflex, which was performed by only 60.4% (n = 29) of responders. Almost all participants (95.8%, n = 46) recognized the risk factors for retinopathy of prematurity (ROP). The majority of pediatricians (n = 46, 95.8%) would immediately refer a child with suspected glaucoma to an ophthalmologist. In regard to leukocoria, the majority recognized cataract (n = 38, 79.2%) and retinoblastoma (n = 40, 83.3%) as major causes of this condition. Almost all pediatricians (n = 46, 95.8%) would immediately refer a child with leukocoria to an ophthalmologist. On the subject of refractive errors, only 62.5% (n = 30) of physicians confirmed that refractive errors could occur in children of any age and that they may need glasses. Nonetheless, 70.8% (n = 34) stated that refractive errors could be a cause of squint in children. Amblyopia and underlying central causes of squint were a major concern for most responders with 68.8% (n = 33) and 75% (n = 36), respectively.

CONCLUSION

Although the knowledge of and attitude to eye disease among pediatricians were at a satisfactory level, the degree of collaboration with ophthalmologists is limited. More workshops need to be held for pediatricians.

Screening premature infants for retinopathy of prematurity in a tertiary hospital in Saudi Arabia

BACKGROUND

Early detection of retinopathy of prematurity (ROP) in preterm infants is critical, especially with advancements in neonatal care and improved survival rates. However, a balance should be found between not missing any ROP requiring treatment and minimizing workload, saving resources, and reducing unnecessary examinations to fragile neonates.

OBJECTIVE

Ascertain whether our current inclusion criteria in screening ROP could be modified to ≤1250 g (while keeping the gestational age at ≤30 6/7 weeks) to reduce the number of screened babies without missing any type I ROP requiring treatment.

DESIGN

Retrospective, record-based study.

SETTING

Referral center.

MAIN OUTCOME MEASURES

ROP outcome and risk factors.

PATIENTS AND METHODS

Neonates screened for ROP in the neonatal intensive care unit of our institution between January 2016 and November 2018 were included. Data collected for each neonate included demographics, ROP details and risk factors. We used a revised version of ROP screening guidelines by the American Academy of Pediatrics.

SAMPLE SIZE AND CHARACTERISTICS

155 neonates (median birth weight, 1035 g; range, 527-1982 g; and gestational age range, 23-39 weeks).

RESULTS

Of 1393 live births, 155 babies met the inclusion criteria. ROP occurred in 60/155 (38.7%) screened babies while sixteen developed threshold ROP. All 16 babies who required treatment had both a birthweight ≤1000 g and a gestational age of ≤30 weeks. Using the screening recommendations of the Canadian Policy, more infants would have been screened without diagnosing a case of ROP of any stage, and no case of ROP requiring treatment would have been missed compared to the AAP recommendations.

CONCLUSION

ROP requiring treatment is a rare occurrence in premature infants with a gestational age >30 weeks and body weight >1000 g at our institute. Nonetheless, this is not an attempt to alter national screening guidelines. A multicenter prospective study with an adequate sample size is needed to assess whether guidelines for ROP screening should be altered in this category of neonates.

LIMITATIONS

Retrospective design.

CONFLICT OF INTEREST

None.

Incidence and risk factors of retinopathy of prematurity in three neonatal intensive care units in Palestine

BACKGROUND

Severe Retinopathy of Prematurity (ROP) is a serious vasoproliferative disorder that can affect extremely premature infants. It continues to be one of the most important preventable causes of blindness in children. Our study is aimed at finding the incidence of ROP and its association with some risk factors in Palestine.

METHODS

From the 1st of January 2016 to 31st December 2016, a total number of 115 infants who met the criteria for ROP screening in three neonatal intensive care units were included in the study. The medical records of infants were reviewed retrospectively and multiple factors that may be associated with the development of ROP were collected manually.

RESULTS

The incidence of ROP and severe type 1 ROP that require treatment was 23.5 and 11.3% respectively. After conducting univariate analysis of risk factors, statistically significant risk factors affecting the development of ROP in our study were: low gestational age, low birth weight, type of multiple gestation, the presence of affected sibling, low level of Hemoglobin at birth, respiratory distress syndrome, low Hemoglobin level, blood transfusion and days on oxygen supplements with either mechanical, non-mechanical methods or both combined. High bilirubin levels were found as a protective factor against the development of ROP. However, when a multivariate analysis was performed, only low gestational age, total days on oxygen supplement and high bilirubin levels were significant regarding the development of ROP.

CONCLUSION

The incidence of ROP is considered a relatively low percentage compared to neighboring countries that have higher levels of human development index. Statistically significant risk factors need to be considered when clinicians deal with premature infants.

Retinopathy of prematurity: applicability and compliance of guidelines in Hong Kong

OBJECTIVE

To analyse the incidence, application and compliance to Royal College of Ophthalmologists retinopathy of prematurity (ROP) screening recommendations and subsequent treatment of ROP in a neonatal intensive care unit of a large tertiary referral centre in Hong Kong.

DESIGN

A retrospective review was performed for all eligible premature neonates screened for ROP over a 7-year period from June 2008 to December 2015 in our local tertiary neonatal intensive care unit in Prince of Wales Hospital, Hong Kong, using the Royal College of Ophthalmologists ROP screening guideline (2008). Comparison between established UK and American screening guidelines were analysed for their applicability in our locality.

RESULTS

A total of 602 infants were screened, with the incidence of ROP in 28.2% and type 1 ROP in 3.8%, and indirect diode laser performed in all type 1 ROP cases. Overall, adherence for screening criteria was 99.7%, with the average time to commence first screening at 4 weeks postnatal age. Of the 602 cases, 94 (15.6%) were early and 35 (5.8%) were later than the guidelines, of which only 5 (0.8%) of late-screened cases developed ROP requiring treatment. Subsequent treatment of ROP for all the late-screened cases was not delayed.

CONCLUSIONS

Current ROP screening using the UK guidelines (2008) is applicable, effective and safe to our predominantly Asian population in Hong Kong, with a low rate of delayed screening.

Incidence of retinopathy of prematurity at two tertiary centers in Jeddah, Saudi Arabia

Purpose

To review the incidence and risk factors for retinopathy of prematurity (ROP) King Faisal Specialist Hospital and King Abdulaziz University Hospital in Jeddah, Saudi Arabia.

Material and methods

In this prospective cohort study, preterm infants who were admitted to a neonatal intensive care unit from 2012 to 2013 were evaluated for ROP. Inclusion criteria were, preterm infants with gestational age <32 weeks and/or birth weight <1500 g. The risk factors that were assessed were intraventricular hemorrhage, patent ductus arteriosus (PDA), sepsis and hydrocephalus. The relative risk was used to measure the risk and logistic regression was used to adjust for confounding factors. Statistical significance was indicated by p < 0.05.

Results

Thirty-one of 92 (33.7%) preterm infants had unilateral or bilateral ROP. The mean gestational age was 26.7 weeks (range, 24–29 weeks) and mean birth weight was 0.843 kg (range, 0.606–1.450 kg). There were 7 infants with stage 1 ROP, 10 infants with stage 2, 14 infants with stage 3 and no cases of stage 4 or 5. Twelve (13%) infants had plus disease and received laser therapy within 72 h of diagnosis. Statistically significant risk factors for ROP were PDA (p = 0.0005) and intraventricular hemorrhage (p = 0.0005).

Conclusion

The incidence of ROP was 33.7% and risk factors were PDA and intraventricular hemorrhage. Laser therapy was very effective for the treatment of plus disease and preventing progression of ROP. Clinicians should assess for potential risk factors when monitoring premature infants.

The incidence and risk factors of severe retinopathy of prematurity in extremely low birth weight infants in Turkey

Background

The aim of this study was to identify the incidence of severe retinopathy of prematurity (ROP) requiring laser treatment and the overall incidence of ROP in extremely low birth weight (ELBW) infants, and to evaluate the associated risk factors for developing severe ROP in ELBW infants in Turkey.

Material/Methods

This retrospective, case-control, tertiary care-hospital based study included 235 ELBW infants screened for ROP. The incidence of the onset of ROP and severe ROP requiring laser treatment were assessed. The relationship between various clinical risk factors, and the development of severe ROP and onset of ROP were analyzed using univariate analysis and multivariate logistic regression analysis.

Results

The overall incidence of any stage ROP and severe ROP requiring laser treatment in ELBW infants was 75.5% and 38.7%, respectively. Severe ROP requiring laser treatment in ELBW infants was significantly associated with various independent risk factors, including blood transfusion (P=0.002), gestational age at birth (P<0.001), gestational weight at birth (P=0.001), culture-proven sepsis (P=0.047).

Conclusions

The severity of ROP may increase as weight at birth and gestational age at birth decrease, and in those with culture-proven sepsis as well as in those that receive blood transfusion. Clinicians should be aware of the presence of these risk factors when treating ELBW premature infants. Early detection and prevention of sepsis and reducing the number of blood transfusions may decrease the incidence of severe ROP requiring laser treatment.

Type I retinopathy of prematurity in infants with birth weight less than 1251 g: incidence and risk factors for its development in a nursery in Kuwait

Purpose:

To report the rate of acute retinopathy of prematurity (ROP) and Type I ROP among infants with birth weight (BW) <1251 g and identify the risk factors for the development of Type I ROP.

Materials and Methods:

A retrospective review of ROP records of infants with BW <1251 g was performed to identify infants with acute ROP and Type I ROP. Infants with Type I ROP were compared with those without Type I ROP to assess the risk factors for the development of Type I ROP. P < 0.05 was statistically significant. Multivariate analysis was performed and odds ratio (OR) and 95% confidence intervals (CI) were calculated.

Results:

Among the 207 infants with BW <1251 g, acute ROP occurred in 154 infants (74.4%) and Type I ROP in 95 eyes of 50 infants (24.4%). The numbers of infants with BW <750 g and BW <1000 g were 19.3% and 58.4%, respectively, and the incidences of Type I ROP were 50% and 36.4%, respectively, among them. Forty-four (46.3%) eyes were treated at stage 2+ ROP in zone I or II. All the eyes treated for Type I ROP showed complete regression. Gestational age at birth (OR 0.657, 95% CI: 0.521-0.827; P < 0.0001) and number of ventilated days (OR 1.017, 95% CI: 1.005-1.029; P = 0.006) were identified as independent risk factors for the development of Type I ROP.

Conclusions:

The rate of Type I ROP in this study is higher than that in previous studies due to the higher number of infants with BW <1000 g in our cohort and the treatment of more eyes with stage 2+ ROP. However, all the treated eyes had a favorable outcome. Gestational age at birth and number of ventilated days were independent risk factors for the development of Type I ROP.