The Third Epidemic of Blindness: Early ROP Screening vs. KIDROP Conventional Screening of Retinopathy of Prematurity in Neonates- A Prospective Cohort Study
DOI:
https://doi.org/10.6000/1929-4247.2024.13.03.3Keywords:
Screening, preterm, retinopathy of prematurity, NICUAbstract
Aim: To assess the benefits of initiating early Retinopathy of Prematurity (ROP) screening compared to conventional KIDROP screening and study the incidence, severity, and risk factors of ROP.
Methods: Preterm neonates born with weight < 2000 g and/or < 36 weeks of gestation admitted to the Level III-A neonatal intensive care unit (NICU), BLDE (Deemed to be University), Shri B. M. Patil Medical College, Hospital and Research Centre, were enrolled in the study. The in-house retina specialist performed Early ROP screening at 10-14 days of life, depending on the gestational age at birth. Subsequently, KIDROP conventional screening was done at 3 to 6 weeks of life by the Karnataka Internet Assisted Diagnosis for Retinopathy of Prematurity (KIDROP) team once weekly. ROP findings were recorded as per the standard ICROP norms. The data was analyzed for gestational age, birth weight, and systemic factors predisposing to ROP.
Results: The incidence of Early ROP was 14% (7/50). Of the neonates diagnosed with ROP, 43% had a gestational age of < 30 weeks, and 86% had birth weight in the group 1000- 1500 g. The incidence of type 1 ROP is 28.5% (2/7). The significant predictors of the increased risk of ROP were birth weight, gestational age, prolonged oxygen therapy, synchronized intermittent mandatory ventilation (SIMV), sepsis, patent ductus arteriosus (PDA), and nutrition, including MOM & Parenteral Nutrition.
Conclusion: Early enrolment of neonates for ROP screening in the NICU itself ensures early diagnosis and timely intervention and also ensures compliance and routine follow-up of these neonates. 14% had early ROP, which suggests the need to redefine the ROP screening criteria.
References
March of Dimes, PMNCH, Save the Children, WHO. Born Too Soon: The Global Action Report on Preterm Birth. Eds CP Howson, MV Kinney, JE Lawn. World Health Organization. Geneva, 2012. Available online: http://www.who.int/pmnch/media/news/2012/201204_borntoosoon-report.pdf
Dutta S, Raghuveer T, Vinekar A, et al. Can We Stop the Current Epidemic of Blindness From Retinopathy of Prematurity? Indian Pediatr 2016; 53: S80-S84.
Azad R. Prevention of blindness due to retinopathy of prematurity: a national movement. Indian J Pediatr 2014; 81: 1373-5. https://doi.org/10.1007/s12098-014-1411-x DOI: https://doi.org/10.1007/s12098-014-1411-x
Vinekar A, Jayadev C, Mangalesh S, et al. Role of tele-medicine in retinopathy of prematurity screening in rural outreach centers in India - a report of 20,214 imaging sessions in the KIDROP program. Semin Fetal Neonatal Med 2015; 20: 335-45. https://doi.org/10.1016/j.siny.2015.05.002 DOI: https://doi.org/10.1016/j.siny.2015.05.002
Gilbert C, Rahi J, Eckstein M, et al. Retinopathy of prematurity in middle-income countries. Lancet 1997; 350: 12-14. https://doi.org/10.1016/S0140-6736(97)01107-0 DOI: https://doi.org/10.1016/S0140-6736(97)01107-0
Gopal L, Sharma T, Ramchandran S. Retinopathy of prematurity: A study Indian J Ophthalmol 1995; 43: 59-61
Jalali S, Matalia J, Hussain A, Anand R. Modification of screening criteria for retinopathy of prematurity in India and other middle-income countries Am J Ophthalmol 2006; 141: 966-8. https://doi.org/10.1016/j.ajo.2005.12.016 DOI: https://doi.org/10.1016/j.ajo.2005.12.016
Vinekar A, Dogra MR, Sangtam T, Narang A, Gupta A. Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 grams at birth: Ten-year data from a tertiary care center in a developing country Indian J Ophthalmol 2007; 55: 331-6. https://doi.org/10.4103/0301-4738.33817 DOI: https://doi.org/10.4103/0301-4738.33817
Charan R, Dogra MR, Gupta A, Narang A. The incidence of retinopathy of prematurity in a neonatal care unit. Indian J Ophthalmol 1995; 43: 123-6.
Rekha S, Battu RR. Retinopathy of prematurity: incidence and risk factors. Indian Pediatr 1996; 33: 999-1003.
Chattopadhyay MP, Pradhan A, Singh R, Datta S. Incidence and risk factors for retinopathy of prematurity in neonates. Indian Pediatr 2015; 52: 157-8. https://doi.org/10.1007/s13312-015-0594-1 DOI: https://doi.org/10.1007/s13312-015-0594-1
Pejaver RK, Bilagi AP, Vinekar A. National Neonatology Foundation’s Evidence-Based Clinical Practice Guidelines 2010. Retinopathy of Prematurity (NNF India, Guidelines) 2010: 253-62.
Preterm‑associated visual impairment and estimates of retinopathy of prematurity at regional and global levels for 2010. Pediatr Res 2013; 74: 35-49. https://doi.org/10.1038/pr.2013.205 DOI: https://doi.org/10.1038/pr.2013.205
NNF India Evidence-based Clinical Practice Guidelines January 2020, available online www.nnfi.org/cpg
Sapieha P, Joyal JS, Rivera JC, Kermorvant-Duchemin E, Sennlaub F, Hardy P, et al. Retinopathy of prematurity: understanding ischemic retinal vasculopathies at an extreme of life. J Clin Invest 2010; 120(9): 3022-32. https://doi.org/10.1172/JCI42142 DOI: https://doi.org/10.1172/JCI42142
Fulton AB, Hansen RM, Moskowitz A, Akula JD. The neurovascular retina in retinopathy of prematurity. Prog Retin Eye Res 2009; 28(6): 452-82. https://doi.org/10.1016/j.preteyeres.2009.06.003 DOI: https://doi.org/10.1016/j.preteyeres.2009.06.003
Fortes Filho JB, Eckert GU, Valiatti FB, Dos Santos PG, da Costa MC, Procianoy RS, et al. The influence of gestational age on the dynamic behavior of other risk factors associated with retinopathy of prematurity (ROP). Graefes Arch Clin Exp Ophthalmol 2010; 248: 893-900. https://doi.org/10.1007/s00417-009-1248-6 DOI: https://doi.org/10.1007/s00417-009-1248-6
Dogra MR, Narang S, Biswas C, Gupta A, Narang A. Threshold retinopathy of prematurity: Ocular changes and sequelae following cryotherapy. Indian J Ophthalmol 2001.
Hungi B, Vinekar A, Datti N, Kariyappa P, Braganza S, Chinnaiah S, et al. Retinopathy of prematurity in a rural Neonatal Intensive Care Unit in South India - A prospective study. Indian J Pediatr 2012; 79: 911-5. https://doi.org/10.1007/s12098-012-0707-y DOI: https://doi.org/10.1007/s12098-012-0707-y
Ashok KM, Rajalakshmi AR, Gunasekaran D, Sreeraaganidhi A study of risk factors for retinopathy of prematurity in a medical college hospital in South India to evaluate the criteria for screening for retinopathy of prematurity. J Curr Trends Clin Med Lab Biochem 2014; 2: 31-6.
Murthy KR, Murthy PR, Shah DA, Nandan MR, Niranjan HS, Benakappa N. Comparison of the profile of retinopathy of prematurity in semiurban/rural and urban NICUs in Karnataka, India. Br J Ophthalmol 2013; 97: 687-9. https://doi.org/10.1136/bjophthalmol-2012-302801 DOI: https://doi.org/10.1136/bjophthalmol-2012-302801
Hellström A, Kermorvant-Duchemin E, Johnson M, et al. Nutritional interventions to prevent retinopathy of prematurity. Pediatr Res 2024. https://doi.org/10.1038/s41390-024-03208-1 DOI: https://doi.org/10.1038/s41390-024-03208-1
Published
How to Cite
Issue
Section
License
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .