Risk factors for the development and progression of retinopathy of prematurity in preterm infants in Indonesia

BACKGROUND

Risk factors other than supplemental oxygen might play a role in the development of retinopathy of prematurity (ROP). In Indonesia ROP occurs in infants up to 34 weeks and 2000 g. Risk factors for the development of ROP in Indonesian NICUs have not been evaluated. Our aim was to identify other risk factors than the use of oxygen in the development and progression of ROP in preterm infants in Indonesia.

METHODOLOGY

Data on 98 preterm infants with ROP and 77 controls were collected from four NICUs and two eye centers in Jakarta, Indonesia, between 2009 and 2014. We used multivariate logistic regression analysis to determine the relationship between infants and environmental variables and the development and progression of ROP. We obtained variables for ROP severity by using Cox regression analysis.

RESULTS

Factors associated with the development of ROP were birthweight (BWt), intrauterine growth retardation (IUGR), exchange transfusion, duration of oxygen supplementation, minimum saturation monitor setting, and socioeconomic factors. Regarding the progression, gestational age (GA), out-born, duration of supplemental oxygen, minimum saturation monitor setting, and socioeconomic factors were identified as risk factors.

CONCLUSION

The use and control of supplemental oxygen are the main risk factors for the development and progression of ROP in preterms in Indonesia. Additionally, we confirm that GA, BWt, and IUGR are risk factors. Moreover, we found exchange transfusion to be a risk factor, and we found a lower rate of ROP in infants from a lower socioeconomic background. These risk factors apply to infants with a GA up to 34 weeks and a BWt up to 2000 g.

Multicentre survey of retinopathy of prematurity in Indonesia

BACKGROUND

The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants.

OBJECTIVE

To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia.

SETTING

Data were collected from 34 hospitals with different levels of care: national referral centres, university-based hospitals, and public and private hospitals.

METHODS

A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016-2017 in relation to gestational age and birth weight.

RESULTS

We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28-32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%-5%. Both mortality and the incidence of ROP were highest in university-based hospitals.

CONCLUSIONS

In the 2016-2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016-2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia.

Norrie disease gene polymorphism in Indonesian infants with retinopathy of prematurity

OBJECTIVE

Retinopathy of prematurity (ROP) is a major cause of blindness in newborn infants, which also occurs in low-income and middle-income countries. Why ROP progresses in some infants while it regresses in others is still presently unknown. Studies suggest that genetic factors might be involved. Mutations in the Norrie disease (ND) gene are suspected to be related to advanced ROP development. Indonesia is a country with relatively high incidence of ROP, yet the role of these genetic factors in the pathogenesis of ROP cases is still unknown. The study aimed to investigate the presence of mutations in ND on the X chromosome in infants with both non-advanced and advanced ROP in Indonesia.

METHODS AND ANALYSIS

This is a case-control study of polymorphisms in six variants within the ND gene in exon 3, C597A, L108P, R121W, A105T, V60E and C110G, in preterm newborn infants in four major hospitals in Greater Jakarta, Indonesia.

RESULTS

We included 162 preterm newborn infants. ROP was diagnosed in 83 infants, and 79 infants served as controls. Among those with ROP, 57 infants had type 2, while others had type 1. We did not find any gene polymorphisms in any of the infants with ROP nor in the control group.

CONCLUSION

We conclude that it is very unlikely that the six polymorphisms in exon 3 of the ND gene studied in this paper are involved in the development or progression of ROP in preterm infants in our population sample in Indonesia.

Eleven years of retinopathy of prematurity in one neonatal intensive care unit in Jakarta, Indonesia

BACKGROUND

Retinopathy of prematurity (ROP) is a well-known complication in preterm infants. Data on the incidence of ROP in Indonesia, in relation to birth weight (BW) and gestational age (GA), are limited.

OBJECTIVE

To report the incidence of ROP in one of the oldest and largest neonatal intensive care unit (NICU) in Indonesia.

METHODS

We studied the incidence and severity of ROP in inborn infants with a BW of ≤1500 g and/or GA of ≤32 weeks, who were admitted to the NICU of Harapan Kita Women and Children Hospital, Jakarta. In addition, infants with a higher BW and GA, receiving more than 40% oxygen for a longer period, were screened.

RESULTS

In 2005-2015, 182 infants were born with a BW of <1000 g and 437 with a weight of 1000-1500 g. In the <1000 g group, 27 (46%) of the screened infants showed no ROP, 22 (37%) showed ROP 1-2 and 10 (17%) showed ROP 3-5. In the 1000-1500 g group, 172 (68%) were without ROP, 71 (28%) with ROP 1-2 and nine (4%) with ROP 3-5. Twenty-two (13%) of the 163 screened infants weighing 1500-2000 g showed ROP 1-2 and two (1.2%) had ROP 3-5. Eight (18%) of the 44 screened infants born with a BW of more than 2000 g showed ROP 1-2 and none showed ROP 3-5.

CONCLUSION

The total incidence of ROP as well as severe ROP in infants with a BW of <1000 g and 1000-1500 g in our NICU is higher than in a developed country. ROP in Indonesia is also seen in infants with a BW of 1500-2500 g. Increasing the awareness of the risks of oxygen as well as better equipment to monitor oxygen delivery is essential.

Retinopathy of prematurity in Indonesia: Incidence and risk factors

BACKGROUND

Retinopathy of prematurity (ROP) is a vaso-proliferative disease of the eye, which mainly affects preterm newborn infants with an incompletely vascularized retina. The incidence of ROP has increased in industrialized countries due to the increased survival of extremely low birth weight (ELBW) infants. ROP is also increasing in developing countries like Indonesia, where it is most likely due to the improved survival of ELBW infants.

OBJECTIVE

To ascertain the incidence of ROP and possible risk factors associated with the development of ROP in preterm infants in Indonesia.

METHODS

We reviewed the literature on the incidence and potential risk factors for the development of ROP in Indonesia, obtained data from three referral eye clinics and added data from our institution.

RESULTS

The reported incidence of all stages of ROP in infants with a gestational age of <32 weeks ranged from 18-30%. One study showed that ROP also occurred at older gestational ages. Blindness due to ROP was seen in infants up to 35 weeks and with a birth weight of 2000 g.

CONCLUSION

Retinopathy of prematurity is an important cause of ocular morbidity and blindness in Indonesia. The overall incidence of ROP in infants born below 32 weeks in Indonesia is higher than in developed countries, and it is seen in infants with older gestational ages. This might be due to a less strict monitoring during the use of oxygen in Indonesia compared to industrialized countries.