Incidence and Risk factors of Retinopathy of Prematurity at a tertiary neonatal care unit in eastern Nepal

Retinopathy of Prematurity in Infants with Birth Weight ≥1250 Grams—Incidence, Severity, and Screening Guideline Cost-Analysis

PURPOSE:The aim of this study is to compare the incidence and severity of retinopathy of prematurity (ROP) in premature newborns of Syrian refugees and those of Turkish origin.METHODS:This retrospective, the single-center study included 1545 premature infants assigned to two groups based on maternal origin. Group 1 comprised 1366 premature infants of Turkish origin, and Group II comprised 179 premature infants born to Syrian refugees. All the premature infants were screened for ROP by the same ophthalmologist who is experienced in the screening and treatment of ROP. All data including gestational age (GA), birth weight (BW), the presence of ROP, and severe ROP collected from 2014 to 2017 were recorded for each group. The outcomes were compared between the two groups.RESULTS:The mean GA at birth was 30.6 ± 2 weeks and was significantly lower in Group II (P = 0.03). The overall incidence of ROP was similar in both groups. The incidence of severe ROP in Group II was nearly seven times higher than in Group I (1.5% and 10%, respectively). The incidence of severe ROP seen in Group II evaluated according to different ranges of GA and BW was higher than in Group I.CONCLUSION:The higher incidence of severe ROP in the premature newborns of Syrian refugees could play an important role in identifying ongoing health problems of refugees.

BackgroundRetinopathy of prematurity (ROP) is a vascular retinal disease that can cause low vision or blindness and affects premature newborns of very low birth weight.ObjectivesThe purpose of this study was to determine the incidence and risk factors for ROP among very premature infants in Mashhad located northeast of Iran.Material and MethodsIn this cross-sectional study performed between 2006 and 2010, predisposing factors and severity of ROP were evaluated in very premature infants (<32 gestational weeks). Consecutive infants were enrolled at birth and screened for ROP at 4 to 6 weeks of age by indirect ophthalmoscopy. Severe ROP was defined as stage 4 or 5. Chi-square, Student’s t-, and Fisher’s test were used for statistical analysis.ResultsThe incidence of ROP was 26.2%. Significant differences between the ROP and control groups were observed, these include; gestational age, sex, birth weight, Apgar score, durationof parenteral nutrition, oxygen therapy, phototherapy, maximum PaO2 and minimum SpO2 (P < 0.05). Severe ROP was seen in 31.4% (11/32) of ROP cases (5.4% of newborns).ConclusionThe incidence of ROP is relatively high in this region. Risk factors for ROP among very premature infants include hypoxia, severe hyperoxia, relatively low blood SPO2, gestational age, birth weight, and Apgar score.

Background Retinopathy of prematurity (ROP) is one of themain causes of visual impairment in premature infants.Objective To determine the incidence and risk factors for ROPin premature infants.Methods This retrospective study included premature infantsborn in Stella Maris Women's and Children's Hospital and admittedto the neonatal intensive care unit (NICU) and NeonatologyDepartment from November 2009 to May 2012. We included allpremature infants with body weight (BW) &lt; 1500 g or gestationalage (GA) &lt; 32 weeks, and selected infants with BW 1500 - 2000g or GA &gt; 32 weeks with unstable clinical courses who had beenscreened for ROP. Data was analyzed with Fisher's exact test andindependent t test.Results Of the 48 premature infants in the study, ROP wasdetected in 6 (12.5%) of the subjects. Stages ofROPwere classifiedaccording to the International Classification ofRetinopathyof Prematurity. Stage 1 ROP was detected in 1 (2.1 %) subject;stage 2 ROP was detected in 3 (6.25%) subjects; and stage 3ROP was found in 2 ( 4.2%) subjects. The 2 infants with stage3 ROP required surgery. No ROP was detected in infants withGA ~30 weeks or BW &gt; 1250 g. Respiratory distress syndrome(RDS), sepsis, blood transfusion, and apnea were found to beassociated with development ofROP. Duration of oxygen therapywas found to be a significant risk factor for ROP in a comparisonof the no ROP group to the ROP group: 14.0 (SD 9.508) daysvs. 3.81 (SD 5 .218) days, respectively (P&lt;0.05). In addition,the duration of continuous positive airway pressure (CPAP)usage was also a significant risk factor for ROP, with 1.83 (SD1.329) days in the ROP group vs. 0.76 (SD 1.122) days in theno ROP group (P&lt;0.05).Conclusions The incidence of ROP in the premature infants inour study is 12.5%. Retinopathy of prematurity is associated withlower BW, lower GA, lower Apgar score at the 5th minute, RDS, sepsis, apnea, blood transfusion, aminophylline usage, as well aslonger duration of oxygen therapy and CPAP usages.

Objective To investigate whether the incidence and severity of retinopathy of prematurity (ROP) differs between infants conceived naturally and those who were in vitro fertilization (IVF),and to analyze ROP-related factors,with a comparative case series.Methods This was a study on premature infants who required screening and treatment of ROP in the Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University,carried out between January 2008 and April 2012.One thousand and one hundred eighty three infants met the study criteria and were divided into two groups:natural conception (group Ⅰ,1058 infants) and IVF (group Ⅱ,125 infants).Multiple variables were recorded,including birth weight (BW),gestational age (GA),number of births (NOB,singleton/twins/triplets),type of conception (natural conception/IVF),neonatal respiratory distress syndrome (NRDS),patent ductus arteriosus (PDA),neonatal asphyxia,neonatal hyperbilirubinemia (NHB),intracranial hemorrhage (IH),congenital heart disease (CHD),neonatal anemia,neonatal sepsis,and bronchopulmonary dysplasia (BPD).The results of ophthalmological examinations were also recorded.The incidence of ROP between groups was compared with the Pearson Chi-square test.We applied Spearman correlation analysis to identify the variables that were most significantly associated with ROP.Results There were 138 infants of ROP in group Ⅰ (total 1058,13.0％),and 17 in group Ⅱ (total 125,13.6％),without significant difference in the presence of ROP between two groups (P ＞ 0.05).No significant difference was found in the presence of ROP affected by BW,GA,NOB,NRDS and other diseases between two groups (P ＞ 0.05).A significantly inverse association was found between ROP and BW (P ＜ 0.05),and between ROP and GA (P ＜ 0.05).No association was found between ROP and NOB (P ＞ 0.05).There was no significant difference in the presence of diseases between infants conceived naturally and those by IVF in group ROP (P ＞ 0.05).A significant association was found between ROP and NRDS (P ＜ 0.05).No association was found between ROP and diseases (PDA,neonatal asphyxia,NHB,IH,CHD,neonatal anemia,neonatal sepsis,and BPD).Conclusions Our study shows that IVF was not a risk factor for ROP. Key words: Fertilization in vitro; Fertilization; Retinopathy of prematurity; Incidence ; Retrospective studies

Objective To explore the incidence and related factors of retinopathy of prematurity (ROP) in twins. Methods The incidence and related factors of 109 pairs of twin premature infants were analyzed retrospectively in 218 cases of premature retinopathy screening in the Maternal and Child Health Hospital of Jiaxing during January 2012 to February 2014 Sex, birth weight, nasal oxygen breath, continuous positive airway pressure (CPAP), mechanical ventilation, blood transfusion, and others concominant disease such as asphyxia, sepsis, respiratory distress, congenital heart disease, and hypoglycemia were recorded. Two-sample t test and Logistic regression analysis were used to investigate the risk factors of ROP. Results The incidence of ROP in twin premature infants was 10.56%. There was no significant difference (P>0.05) of the incidence of ROP between lighter and heavier groups. When compared ROP group to normal fundus of premature babies in gestational age, birth weight, and Apgar score, postnatal pulmonary surfactant application, nasal oxygen breath, CPAP, mechanical ventilation, blood transfusion, anemia, asphyxia, respiratory distress, hypoalbuminemia, septicemia hypoglycemia, pulmonary hyaline membrane disease, congenital heart defects, there were statistical differences (P<0.05). Logistic regression analysis indicated that low gestational age, asphyxia, septicemia and hypoglycaemia were the possible risk factors of ROP. Conclusions The weight of twin premature infants is not a major risk factor for ROP. Gestational age, asphyxia, septicemia, and hypoglycaemia are the most important risk factors in the development of ROP. Key words: Twins; Retinopathy of prematurity; Incidence

To determine the incidence and risk factors of retinopathy of prematurity (ROP) among premature infants. The fundus examination data of 2185 cases of premature infants [birth body weight ≤ 2000 g or gestational age (GA) ≤ 34 weeks] in neonatal intensive care unit of Bayi Children's Hospitals in Beijing between January 2009 and December 2010 were collected and retrospectively analyzed. Of 2185 cases of premature infants (1571 had used supplemental oxygen) received RetCam-II ophthalmoscopy screening, 287 cases developed ROP with the incidence of 13.1% according to the international classification of ROP (ICROP), including 34 cases (11.9%) suffering from zone I, 147 cases (51.2%) from zone II, and 106 cases (36.9%) from zone III. Stage 1, 2 and 3 lesions were 117 cases, 142 cases and 28 cases, accounting for 40.8%, 49.5% and 9.7%, respectively, while stage 4 and stage 5 lesions were not found. Thirty-six cases developed plus disease, accounting for 12.5%. Between ROP and Non-ROP groups, there were significant differences in birth weight (1269.9 ± 380.0) g vs (1479.7 ± 359.3) g vs (1633.9 ± 352.3) g, gestational age (30.6 ± 2.0) g vs (32.4 ± 1.8) W and time of supplemental oxygen [Median 10 d (0 to 71 d) vs 2 d (0 to 36 d)]. Among zone I, II and III groups, there were significant differences in birth weight (1269.9 ± 380.0) g vs (1479.7 ± 359.3) g vs (1633.9 ± 352.3) g, gestational age (29.3 ± 2.2) W vs (30.5 ± 1.9) W vs (31.2 ± 1.8) W and time of supplemental oxygen[Median 14 d (0 to 52 d)vs 10 d (0 to 71 d) vs 8 d (0 to 52 d)] (χ(2) = 257.5, 371.7, 6.695; P < 0.05), while among stage 1, 2 and 3 groups, there were also significant differences in birth weight (1593.3 ± 413.7) g vs (1481.3 ± 336.7) g vs (1325.3 ± 313.7) g, gestational age (30.9 ± 2.0) W vs (30.6 ± 1.9) W vs (29.5 ± 1.7) W and time of supplemental oxygen [Median 8 d (0 to 52 d) vs 11 d (0 to 65 d) vs 12 d (0 to 71 d)] (χ(2) = 230.8, 273.5, 6.695; P < 0.05). In 1004 cases admitted in 2009, 150 developed ROP with the incidence of 14.9%; while in 1181 cases admitted in 2010, 137 developed ROP with the incidence of 11.6%. There was significant differences in the incidence of ROP between these two years (χ(2) = 5.305, P < 0.05). Thirty-eight infants (1.7%) received laser therapy and only 3 infants progressed to stage 4 after laser therapy. Three infants with laser failed stopped progress after vasectomy. Finally, all patients were cured without blindness. Less birth weight, shorter GA and time of supplemental oxygen are close related to the development of ROP. It is necessary to pay high attention to the screen on premature infants with smaller gestation age, lower birth weight or using oxygen for the reduction or even avoid of blindness.

Incidence and severity of retinopathy of prematurity in extremely premature infants

This study aimed to investigate the correlation between serum 25-hydroxyvitamin D (25(OH)D) levels and retinopathy of prematurity (ROP) in premature infants one month after birth. Preterm infants (gestational age <32 weeks) admitted to the Affiliated Hospital of Qingdao University from 2017 to 2022 were divided into ROP and non-ROP groups based on ROP occurrence any stage. Serum 25(OH)D levels and clinical data were compared between the two groups at 1 month after birth, and the relationship between vitamin D levels and ROP was analyzed. Among the 217 premature infants included, 55 (25.35%) were in the ROP group, and 162 (74.65%) were in the non-ROP group. The ROP group had lower gestational age and birth weight, longer invasive ventilation (IV), non-invasive ventilation (NIV), and oxygen therapy times compared to the non-ROP group. Apgar scores, cesarean delivery, and antenatal steroids ratios were lower in the ROP group, while sepsis and pulmonary surfactant utilization ratios were higher (all p < 0.05). Significant differences in serum 25-(OH)D levels were observed among children in the non-ROP group (14.20 ± 5.07 ng/ml), ROP treated group (7.891 ± 1.878 ng/ml), and untreated group (12.168 ± 4.354 ng/ml) (p < 0.001). Multivariate regression analysis identified antenatal steroids as protective factors and lower birth weight, serum 25-(OH)D levels, long-term invasive mechanical ventilation, and sepsis as independent risk factors for ROP in premature infants. Vitamin D, lower birth weight, long-term invasive mechanical ventilation, and sepsis were associated with incidence of ROP in preterm infants. Vitamin D was associated with the severity of ROP, emphasizing the importance of prudent vitamin D supplementation and regular monitoring of serum 25-(OH)D levels.

Background:To investigate the incidence and risk factors of retinopathy of prematurity (ROP) in two Neonatal Intensive Care Units in North and South of China, respectively.Methods:We studied data concerning 472 infants with gestational age (GA) ≤34 weeks or birth weight (BW) ≤2000 g who were admitted to the Zhujiang Hospital of Southern Medical University and the Fourth Hospital of Shijiazhuang between January 1, 2011 and December 31, 2011. Clinical information about perinatal neonates was collected and was confirmed by reviewing medical charts. The incidence and severity of ROP were assessed in the screened population. Main outcome measures are the incidence and severity of ROP. The relationship of clinical risk factors and the development of ROP were analyzed.Results:The overall incidence of ROP was 12.7%, and the overall incidence of type 1 ROP was 2.3%; 9.4% of infants in Zhujiang Hospital had ROP compared to 15.0% infants in the Fourth Hospital of Shijiazhuang developed ROP, and the difference is statistically significant. ROP was significantly associated with GA (odds ratio [OR]: 0.77 [0.62–0.95], P = 0.015), BW (OR: 0.998 [0.996–0.999], P = 0.008), maternal supplemental oxygen administration before and during delivery (OR: 4.27 [1.21–15.10], P = 0.024) and preeclampsia (OR: 6.07 [1.73–21.36] P = 0.005). The risk factors for ROP are different in two hospitals. In Zhujiang Hospital, BW is the independent risk factors for ROP while GA, BW and preeclampsia in the Fourth Hospital in ShijiazhuangConclusions:Retinopathy of prematurity incidence is different based on area. Incidence of ROP is still high in China. More efforts need to prevent ROP.

Objectives: This study aimed to investigate the incidence and outcomes of retinopathy of prematurity (ROP) among neonates admitted to the neonatal intensive care unit (NICU) at a private tertiary healthcare institution in Saudi Arabia. This research holds particular significance as it is the first of its kind conducted within a private tertiary care hospital in the country. Methods: This retrospective cohort study analyzes the medical records of all preterm infants admitted to our NICU in Riyadh, Saudi Arabia, between January 2023 and January 2024 who were eligible for ROP screening. We gathered data on demographics, ROP incidence, severity, and treatment outcomes. Results: In this study, a total of 105 preterm infants were screened for ROP, with an incidence rate of 31.4%. Notably, 81.8% of ROP cases regressed spontaneously, while 18.2% required treatment with laser therapy or intravitreal ranibizumab injections. The mean gestational age (GA) of infants diagnosed with ROP was 28.1 ± 2.26 weeks, and the average birth weight (BW) was 1116 ± 170 g. Factors such as lower GA, lower BW, prolonged oxygen use, and longer duration of mechanical ventilation (MV) were significantly associated with an increased incidence and severity of ROP. Conclusion: The incidence of ROP in our private tertiary care center aligns with findings from public hospitals in Saudi Arabia. This study underscores the vital role of NICU care in enhancing visual outcomes for preterm infants and highlights the urgent need for early screening and timely intervention.

Purpose: To report the changes in incidence and risk factors of retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) infants over a 15-year period in South China. Methods: The medical records of ELBW infants were retrospectively reviewed through established database of Shenzhen Screening for ROP Cooperative Group. The incidence and severity of ROP were compared among three successive 5-year periods (P1: 2004–2008, P2: 2009–2013, P3: 2014–2018). Gestational age, birth weight, plurality, mode of delivery and gender were analyzed as risk factors for ROP in ELBW infants. Results: Among the 1099 included ELBW infants, 557 (50.7%) had ROP, and 328 (29.9%) had severe ROP. The highest incidence of ROP (87.5%) and severe ROP (82.5%) were seen in P1. From P2 to P3, the incidence of ROP and severe ROP increased from 45.9% to 50.3% for ROP (P < .05) and from 26.4% to 28.3% for severe ROP (P < .05), respectively. Multivariate logistic regression analysis found only gestational age has a significant effect on the incidence of ROP and severe ROP. Conclusions: From 2004 to 2018, the incidence of ROP and severe ROP in ELBW infants in South China was 50.7% and 29.9%, respectively. Controlling for the other risk factors, only gestational age was statistically associated with ROP in ELBW infants.

Objective: We aimed to determine the incidence and screening outcomes of retinopathy of prematurity (ROP) in preterm infants managed at a tertiary neonatal intensive care unit (NICU) and to identify associated risk factors. Material and Methods: Medical records of 454 premature infants who underwent ROP screening between April 2016 and August 2021 were retrospectively analyzed. Infants with birth weight (BW) ≤ 1500 g or ≤32 weeks of gestational age and those with BW > 1500 g or GA > 32 weeks who had an unstable clinical course were included. All of them were born in the same center. Demographic characteristics, potential risk factors for ROP, ocular examination findings, and treatment requirement were recorded. Results: During the five-year study period, ROP was observed in 75 (16.6%) of a total of 454 premature infants with a mean gestational age (GA) of 30.19 ± 2.49 weeks and a mean BW of 2025.15 ± 614.46 g in the NICU. Of these patients, 67 (14.8%) had stage I disease and 8 (1.8%) had stage II disease. Advanced-stage ROP was not detected in any of the cases. The median GA of patients diagnosed with ROP was 29 weeks (22–35) and the median BW was 2100 g (500–3750), which were significantly lower than those without ROP (p < 0.001). When multivariate logistic regression analysis was evaluated with the Wald method, the accuracy rate of the model examining the combined effect of GA, intraventricular hemorrhage (IVH), respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and surfactant treatment was 85.9%. In this model, gestational age (OR: 0.712, p < 0.001), IVH (OR: 2.915, p = 0.010), RDS (OR: 2.129, p = 0.004), NEC (OR: 3.679, p < 0.001), PDA (OR: 2.434, p = 0.021), and surfactant treatment (OR: 2.271, p = 0.002) were found to be independent risk factors for ROP development. Conclusions: Small GA and low BW are the main risk factors for the development of ROP. The incidence of ROP was found to be lower than similar studies conducted in our country. While severe ROP cases have been reported in more mature infants in Turkey, our study found no treatment-requiring ROP cases, likely reflecting the higher mean GA and BW characteristics of our cohort.

Purpose: This study aims to estimate the incidence of retinopathy of prematurity (ROP) and investigate its perinatal and neonatal risk factors in a tertiary hospital in Saudi Arabia. Methodology: This was a retrospective cohort study of premature infants admitted to a neonatal intensive care unit at a tertiary hospital in Jeddah, Saudi Arabia, from January 2016 to December 2017. Participants who met the screening criteria for ROP were included and followed up until spontaneous recovery or laser treatment. Results: A total of 119 infants screened, the incidence of ROP was 21.8% (26/119). A plus disease was diagnosed in 15.4% (4/26) of the ROP infants. For most, 80.7% (21/26) of the ROP regressed spontaneously, and 19.2% (5/26) required a laser intervention. The mean gestational age (GA) of infants diagnosed with ROP was 25.62 ± 1.58 weeks and the median birth weight (BW) 750 (interquartile range: 280) g. Lower GA, lower BW, prolonged oxygen therapy, and mechanical ventilation (MV) were significantly related to ROP disease and severity. Requiring resuscitation at birth, a lower Apgar score at 1-min, poor weight gain proportion at 6 weeks, and requiring a blood transfusion were significantly associated with ROP disease. Conclusion: Compared to other local studies, the incidence of ROP was lower in our population. Lower GA, low BW, prolonged oxygen therapy and MV, and poor weight gain at 6 weeks are well-documented risk factors. We recommend close monitoring of weight gain and oxygen therapy and modifying risk factors in preterm infants to lower the incidence and the severity of ROP.

Background: Retinopathy of Prematurity (ROP) is a vasoproliferative disorder affecting the retina of premature infants, leading to potential visual impairment and blindness. With advancements in neonatal care, the incidence of ROP has increased, particularly in developing countries where neonatal care practices vary widely. Aim: To estimate the incidence, perinatal risk factors, and severity of ROP in premature infants. To study the effect of gestational age on incidence of Retinopathy of Prematurity at a tertiary care centre in western India. Design: A hospital-based prospective observational study was conducted. Methods: This study included premature infants who fulfilled inclusion criteria’s. Results: The incidence of ROP in this study was 20% (40/200). The mean gestational age and birth weight in ROP infants were 29.92 ± 1.57 weeks and 1200 ± 176.5 g, respectively. Among the affected infants, 10 infants (25%) had stage 1 ROP, 14 infants (35%) had stage 2 ROP, and 16 infants (40%) had stage 3 ROP. No cases of stage 4 or 5 ROP were observed. Progression to severe ROP was noted in six infants (15%). Oxygen supplementation, respiratory distress syndrome, and apnea were significant risk factors for ROP in the univariate analysis whereas, lower gestational age and low birth weight were significant predictors in the multivariate analysis. Conclusion: This study highlights the substantial burden of ROP in preterm infants and underscores the need for strict neonatal monitoring, timely screening, and appropriate intervention. Early identification of risk factors, particularly oxygen supplementation and respiratory complications, can aid in the prevention and management of ROP, thereby reducing the risk of blindness in premature infants.