Abstract
Purpose. With many preterm babies now surviving as a result of improvement in neonatal care in Nigeria, the incidence of visual impairment/blindness as a result of retinopathy of prematurity (ROP) may rise. We describe our findings after screening starts for the first time in a 15-year-old special care baby unit so as to establish the incidence and risk factors for developing ROP. Methods. A prospective study carried out at the Special Care Baby Unit (SCBU) and Pediatric Outpatient Clinics of the University of Port Harcourt Teaching Hospital between January 1 and October 31, 2012. Fifty-three preterm babies (of 550 neonates admitted within the study period) delivered before 32 completed weeks and weighing less than 1500 g were included in the study following informed consent and the main outcome measure was the development of any stage of ROP. Results. Mean gestational age at birth was 28.98 ± 1.38 weeks. Mean birth weight was 1411 ± 128 g. Out of 550 babies admitted at SCBU, 87 of 100 preterms survived with 53 included in study. Twenty-five (47.2%) had different degrees of ROP with prevalence found to be 47.2%. Prevalence was higher (75%) in babies weighing <1300 g and those delivered before 30-week gestation (58%). Twenty-one (84%) had stage 1 no plus disease and 3 (12%) had stage 2 no plus disease. Only 1 (4%) had threshold disease in Zone 1. None had disease at stage 4 or 5 or AP-ROP. Receiving supplemental oxygen (χ 2 = 6.17; P = 0.01), presence of sepsis (χ 2 = 7.47; P = 0.006), multiple blood transfusions (χ 2 = 5.11; P = 0.02), and delivery by caesarian section (χ 2 = 4.22; P = 0.04) were significantly associated with development of ROP. There were no significant differences with gender, apneic spells, jaundice, or phototherapy. Conclusions and Relevance. All live infants with ROP were noted to regress spontaneously in this study. Though it may not be cost effective to acquire treatment facilities at the moment (the only child with treatable disease died), facilities for screening preterm infants displaying high risk features may be essential as smaller babies are saved.
Highlights
The control of blindness in children is considered a high priority within the World Health Organization’s (WHO’s) VISION 2020—The Right to Sight programme [1]
retinopathy of prematurity (ROP) has a variable course with some eyes showing a mild condition that resolves completely, or it could progress to a vision threatening condition called high risk prethreshold or Type 1 prethreshold ROP
All consecutive premature neonates born before or at 32-week gestation and with a birth weight equal to or less than 1500 g admitted into the Special Care Baby Unit (SCBU) or seen upon discharge on an outpatient basis were included in this study following informed consent from parents
Summary
The control of blindness in children is considered a high priority within the World Health Organization’s (WHO’s) VISION 2020—The Right to Sight programme [1]. Among the causes of blindness in children worldwide is retinopathy of prematurity (ROP) It is a disorder of the developing retinal vessels seen in premature infants, especially those weighing less than 1500 g or younger than 32-week gestational age at birth [2] that may or may not have received oxygen therapy in the neonatal unit [3]. It occurs from interruption of the normal progression of vessels to the peripheral retina as a consequence of premature birth with the resultant high postnatal levels of vascular endothelial growth factor (VEGF). Some eyes show a more aggressive course (“Rush” disease or the newer term aggressive posterior retinopathy of prematurity-(AP-ROP)) with neovascularization forming loops and arteriovenous shunts in Retinal zones
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