Incidence Of ROP Research Articles

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

BackgroundRetinopathy 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...

Pattern of growth and neurodevelopmental outcome of preterm babies born ≤34 weeks of gestation in a South Indian tertiary care hospital

Background: Advances in neonatal care since the early days have led to an increase of survival in preterm infants. Developmental sequelae, however are still a major problem mostly because babies who would previously have been expected to die are now surviving due to neonatal intensive care. There is scarcity of data regarding the outcome of prematurity from low and middle-income countries like India in literature.Methods: 140 preterm babies born at or before 34 weeks of gestation were enrolled and followed up for 1 year. All babies were screened for retinopathy of prematurity and hearing impairment. Anthropometric measurements were taken at 40 weeks, 3 months, 6 months, 9 months and 12 months of corrected age. Neurodevelopmental assessment was done using the Bayley scales of infant and toddler development III at 1 year of age.Results: Among 140 preterm babies, 6 babies expired before 1 year. Majority had catch up growth by 1 year of age. Growth and neurodevelopment were inversely proportional to birth weight and gestational age. Incidence of severe ROP requiring intervention was 8.6% and hearing aid was needed in 4%. At 1 year 24% had cognitive delay, 27% had language delay and 29% had motor delay. Intraventricular hemorrhage, culture proven sepsis, shock and DIC in newborn period were strong predictors of neurodevelopmental impairment.Conclusions: Majority of preterm babies showed catch up growth and had good neuro developmental outcome at 1 year of corrected age.

Incidence and risk factors of retinopathy of prematurity in Western India – Report from A Regional Institute of Ophthalmology

Retinopathy of prematurity is an important cause of childhood blindness amongst premature babies in developing as well as developed world. To report the incidence and risk factors of ROP from a regional institute of Ophthalmology in western India and compare it with the existing scenario. This was prospective observational study of babies born at <34 weeks of gestational and/or <1700 grams birth weight between January 2012 and October 2013. Birth related information viz. O2 administration was recorded in consultation with a neonatologist and babies were evaluated for the presence of ROP. Multivariable logistic regression was used to identify risk factors for any-ROP and severe-ROP requiring treatment. Out of 280 babies screened, any-ROP was seen 54 babies(19.28%) out of which, severe-ROP was found in 28 babies(10.29%).Likelihood of developing any-ROP increased 3 fold (95%CI=1.1 - 6.5), and severe-ROP by 7 fold (95%CI=1.6 - 27.5), if oxygen therapy as administered. Older gestational age was associated with reduced likelihood of developing severe-ROP (Odds ratio=0.79, 95%CI=0.6 - 0.9) but not any-ROP. Twenty four babies (86%) with severe ROP responded well to laser or Bevacizumab therapy while 4 babies developed retinal detachment. This is the first report quoting only incidence and risk factors of ROP from western India. One in 5 babies develop any-ROP similar to that reported across rest of the country. The incidence of severe-ROP requiring treatment appears to be marginally higher, and treatment outcomes in these eyes are similar to that reported in literature.

This issue of ACTA, printed and electronic

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The Severity of Retinopathy in the Extremely Premature Infants.

Objective We aimed to investigate the incidence and the severity of retinopathy of extremely premature infants and to evaluate the risk factors and outcome of the cases. Materials and Methods Out of 200 premature births, we retrospectively reviewed 9 cases that developed ROP. We excluded cases where ROP developed in newborns > 30 weeks of gestational age and cases where medical notes were unavailable or incomplete. Topical drops of cyclopentolate 1% and phenylephrine 5% were instilled and fundoscopy was performed using a direct ophthalmoscope. Results The incidence of ROP was 4.5% in the 9-year period. The infants were divided into two groups. Group 1 included premature infants ≤27 weeks of age and Group 2 included those >27 weeks but ≤ 30 weeks of age. We found that the infants of Group 1 showed advanced stages of ROP in comparison to Group 2. Out of 18 eyes, 11 eyes had stage 3 ROP and they were all found in Group 1 (100% of cases). Conclusion The severity of ROP was associated with earlier gestational age, lower birth weight, and oxygen supplementation. Constant cooperation between physicians and nursing staff is necessary to avoid undetected cases and further prevent ROP related blindness.

Risk factors associated with retinopathy of prematurity among neonates in a tertiary care hospital in Nepal

Background: Retinopathy of prematurity is a vascular retinal disease that can cause blindness in premature new born babies. Several risk factors are associated with the incidence of ROP. Information and data on risk factors associated with ROP in context to Nepalese population is scarcely documented in literature.Objectives: The purpose of this study was to evaluate the risk factors of retinopathy of prematurity in premature infants admitted in the neonatal intensive care unit of Tribhuvan University Teaching Hospital.Methods: Neonates with gestational age of 36 weeks or less and birth weight of 2000 gram or less admitted to neonatal intensive care unit (NICU), during 2013 to 2015 were screened for retinopathy of prematurity. Risk factors and severity of retinopathy of prematurity were evaluated. The initial examination was carried out at 4-6 weeks after birth by indirect ophthalmoscope and retinopathy of prematurity positive and negative infants were compared subsequently. The Chisquare and independent t-tests were used for statistical analysis. A p value less than 0.05 was considered statistically signifi cant.Results: The incidence of retinopathy of prematurity was 22.6% and severe retinopathy of prematurity requiring treatment was observed in 3.2% of 93 neonates who had eye examinations. There was a signifi cant relationship between the occurrence of ROP and birth weight (p=0.000), gestational age (p=0.000), duration of oxygen therapy (p=0.009) and sepsis (p=0.002). However, insignifi cant relationship was observed between the occurrence of retinopathy of prematurity and gender, type of delivery, multiple gestation, premature rupture of foetal membrane, respiratory distress syndrome and hyperbilirubinaemia.Conclusion: The risk factors contributing to development of retinopathy of prematurity showed signifi cant relationship with immaturity, duration of oxygen supplementation and septicaemia.Journal of Kathmandu Medical CollegeVol. 5, No. 1, Issue 15, Jan.-Mar., 2016,page: 28-33

A study on preterm births during 2013–2015, Shiraz, Iran

Preterm birth is the leading cause of neonatal and infant mortality and a substantial portion of neonatal morbidities. The perinatal mortality and morbidity statistics in developing countries are inadequate. In this study, we assessed prevalence and health outcomes of preterm deliveries in tertiary care university hospitals. A retrospective study of hospital records of premature babies born in all the five governmental tertiary care settings during the time interval of 2013–2015 in Shiraz was conducted. Result of this study showed that there was an overall 127.6 premature births per 1000 live births in the study duration. 23.8% of premature newborn had RDS and Incidence of prematurity with RDS was 82.4 per thousand live births. 52.6% of premature newborns were hospitalised in NICU and 8.5% had ROP. Five percent suffered from sepsis and 1% suffered from NEC. Overall mortality was nearly 10% of all the premature newborn. In conclusion, this study showed that premature births and its complications for newborn need to be addressed more in Iran.Impact statementPreterm birth is the leading cause of neonatal mortality and morbidities. Mortality and morbidity statistics related to preterm infants are important healthcare indicators implying the quality of the perinatal health care system and are prerequisite for the identification of problems and implementation of preventive measures. However, the perinatal mortality and morbidity statistics in developing countries are inadequate.The aim of this study was to assess prevalence and health outcome of preterm deliveries in tertiary care university hospitals in Shiraz city, Iran.This study showed that prematurity rate was 12.7%. Among preterm cases, 52.6% were admitted to NICU. RDS occurred among 23.8% of the total premature neonates and 8.2% of the total live births. The incidence of NEC was 1/0% of the total premature neonates and 0.4% of the total live births. The incidence of sepsis was 5% of the premature neonates and 1.9% of the total live births and the incidence of ROP was 8.5% among the premature neonate. The overall mortality of premature neonates was 9.9% of the total premature neonates and 1.2% of the total live births.Rigorous measures for prevention of premature births and its complications for newborns are required in Iran.

A hospital based prospective study to determine incidence of retinopathy of prematurity among premature and low birth weight babies admitted to NICU in Rajarajeshwari Medical College and Hospital

Background: ROP is a disorder of the developing retinal blood vessels in the premature infant retina. Objective of present study is to determine the number of babies affected with ROP among the premature and low birth weight babies admitted to neonatal intensive care unit or attending neonatal follow up clinic at RRMCH Hospital during a period of one year.Methods: This is a prospective observational study conducted in Rajarajeswari Medical College and Hospital Bangalore for 12 months. All eligible babies were screened at Neonatal Intensive Care Unit where temperature is well controlled and the place to handle any emergencies. The pupils were dilated using 2.5% phenylephrine and 0.5% tropicamide eye drops instilled three times into each eye at intervals of 15 minutes about one hour before the scheduled examination.Results: 100 babies were screened and followed up. The incidence of ROP is 40%. Gestational age (&lt;37weeks) and low birth weight (2500g) are important risk factors for ROP. Our study concluded that ROP is an important complication of prematurity.Conclusions: The present study highlights the magnitude of the problem due to ROP in a tertiary care centre. Meticulous fundus examination with indirect ophthalmoscopy in all preterm babies with gestational age &lt;37weeks and birth weight ≤2500gms is essential non invasive method for early detection of ROP and its progression.

Incidence and risk factors of retinopathy of prematurity in neonatal intensive care units: Mansoura, Egypt

Background Retinopathy of prematurity ROP is a leading cause of blindness affecting ∼50 000 children worldwide. The incidence of the disease varies among different countries, it is influenced by the level of perinatal care, the existence of screening programs for early diagnosis. Low birth weight BW, small gestational age GA, other antenatal, postnatal risk factors have been identified with their relation to the severity of the disease. Aim The aim of this research was to study the incidence and risk factors of ROP in preterm babies at neonatal intensive care units, Mansoura city. Patients and methods This study included 402 preterm infants admitted to neonatal intensive care units in Mansoura city in the period from March 2013 to March 2015. Fundus examination was done using indirect ophthalmoscopy and a 28 D lens, and fundus images were captured using wide-field digital fundus camera (Retcam 3). Results Out of the 402 screened preterm babies, 237 (59%) cases had ROP, among whom 101 (42.6%) had stage 1, 114 (48.1%) had stage 2, 12 (5.1%) had stage 3, 10 (4.2%) had aggressive posterior retinopathy, and 24 (10.1%) presented with plus disease. GA, BW, oxygen therapy, sepsis, multiple birth, and cesarean section were factors found to be significantly associated with the disease. Conclusion ROP occurred in 59% of all screened preterm babies. The main risk factors for the development of ROP were GA, BW, oxygen therapy, sepsis, multiple birth, and cesarean section.

Evidence to modify guidelines for routine retinopathy of prematurity screening to avoid childhood blindness in middle-income countries

ObjectiveRetinopathy of prematurity (ROP), the leading cause of childhood blindness around the world, is potentially avoidable. The incidence of ROP varies between countries due to a variety of factors. The aim of this study is to assess the effectiveness of screening criteria in Mexico valid in March 2015 as an example of a middle-income country. MethodsThe medical records of 261 patients from a single center covering a period of 42 months (October 2011–March 2015) were retrospectively analyzed to identify infants with ROP that did not fall within screening criteria set forth by regional health authorities. ResultsOf the 261 infants in our study group, 55 (21.1%) weighed more than 1500g (ranging from 466 to 2910), 129 (49.4%) had a GA >30 weeks (ranging from 22 to 36), and 47 (18%) patients presented both. Overall, the mean birth weight for infants with ROP was 1270.6±365.3g. The mean gestational age was 30.4±2.3 weeks. Following actual AAO/AAP guidelines for ROP screening, 17 infants (6.5%) in our study group would have gone undiagnosed. ConclusionsThese findings show that the valid guidelines at the time of the screening were based on a different population and were not sufficient to detect all ROP cases in a middle-income country. With the update of the Mexican guidelines established in July 2015, the patients from this study would have been screened. Therefore, review and modification of the current screening guidelines in other middle-income countries should be considered to include all babies at risk for ROP.

Ophthalmological follow-up of prematurely born children in preschool age: prospective study of visual acuity, refractive errors and strabismus

Background. Preterm birth is a very relevant problem. Retinopathy of prematurity in its severe forms causes visual impairment or can lead to blindness. The aim of the present study was to describe the visual outcome in prematurely born and full-term children at the preschool age and to evaluate the effects of prematurity per se, ROP, and treatment on visual acuity and refractive errors. Materials and methods. A prospective study on the incidence of ROP during 2006–2008 included 103 preterm infants. 81 had ROP and 22 had no history of ROP; 40 were age-matched healthy children. All underwent a complete ophthalmic examination. Results. Significant myopia (≤ –0.50D) in prematurely born children differed from full-term ones. The ROP treated group had the highest prevalence of myopia (P 2D) was dominant in the premature group (39%) as compared with the control group (0%) (P

Retinopathy of prematurity in neonatal care unit

Background: The objectives of the study were to find the incidence of retinopathy of prematurity and risk factors associated with its development. Methods: Observational study was carried out at tertiary care hospital. Inclusion criteria: All hospitalized preterm infants with birth weight 32 to ≤37 week, with additional risk factors (neonatal & maternal). Results: The overall incidence of ROP in present study was 21.87%. Of these 14.28% had stage І, 64.28% had stage ІІ ROP and 21.42% had plus disease. ROP was bilateral in all 14 neonates. The incidence was high in ELBW (100%), in the gestational age group 28-30 weeks (61.53%). Among the neonatal risk factors, oxygen therapy was a significant risk factor and chances of developing ROP were increased as duration of oxygen therapy increased (>72 hr) (p=0.0005). Episodes of hyperoxia, >3 episodes (p=0.0002) and hypoxia with 2-3 episodes, (p=0.008) were associated with development of ROP. Acidosis, (p=0.006), NEC (p=0.00002), proven sepsis (p=0.002), hyperbilirubinemia requiring intensive phototherapy (p=0.002), PDA (p=0.0007) and partial parenteral nutrition (p=0.02) were other risk factors associated. Mean NICU stay was longer in patients with ROP (p=0.001). Stage 1 and 2 ROP without plus disease showed spontaneous regression (100%) on follow up. Overall incidence of babies requiring laser treatment was 14.28%. Conclusions: We should screen all preterm with birth weight <1500 g and gestational age ≤32 weeks, irrespective of risk factors and babies between 1.5 to 2 kg and between 32 and 37 weeks, having risk factors for ROP.

THE EFFECT OF OXYGEN THERAPY ON THE DEVELOPMENT OF RETINOPATHY OF PREMATURITY

Objective – The aim of this study is to show the effect of oxygen therapy in premature babies on the development of severe ROP. Materials and methods – This retrospective research covered a period of two years, and included 108 premature babies, with birth weight <1500 g and gestational age <33 weeks, at the Children’s Ward of the University Hospital Clinical Centre, Banja Luka. The effects of the length of oxygen therapy and episodes of hypoxia and hyperoxia on the development of severe ROP were analysed. Results – ROP was present in 64 (59.2%) newborns, of which 21 (19.4%) had severe ROP. The incidence of severe ROP is statistically higher with lower birth weight, <1150 g (p<0.01), lower gestational age <30 weeks, longer oxygen therapy and when there were frequent episodes of hy-peroxia and hypoxia. By multiple logistic regression analysis, a very strong connection was established between severe ROP and exposure to episodes of hyperoxia (OR 32.73; CI 4.14-255.37), episodes of hypoxia (OR 14.08; CI 3.81-51.94), and oxygen therapy longer than 10 days (OR 15.54; CI 1.99-120.79). For most risk factors tested, there was a strong connection between severe ROP and birth weight <1250 g, gestational age <30 weeks, respiratory distress syndrome and perinatal asphyxia. Conclusion – Long-term oxygen therapy, prema-turity and low birth weight with hypoxia are important factors in the development of severe ROP. Constant education is necessary of staff regarding the potentially harmfulboth hypoxia and hyperoxia.

Comparison of retinopathy of prematurity incidences between single and multiple premature infants and analysis of related factors

Background Retinopathy of prematurity (ROP) is one of major causes of childhood blindness. Early screening and treatment of ROP is necessary. Objective This study was to analyze the incidence of ROP in single and multiple premature infants and related factors. Methods This study was approved by Ethic Committee of Suzhou Municipal Hospital, and oral informed consent was obtained from the parents of the infants before any medical examinations. Five hundred and four fetus with the gestational age of ≤34 weeks or birth weight of ≤2 000 g were collected in Suzhou Municipal Hospital, of whom 357 infants were single fetus birth and 147 infants were multiple fetus, including 26 twins and 21 three fetus birth. The fundus were examined by RetCamⅡequipment and ROP was determined based on the fundus findings and history of birth. ROP incidences between the single fetus and multiple fetus were compared, and the inducing factors were analyzed. Results Sixty-six infants were ROP in all 504 fetus, with the incidence of 13.10%. The incidence of ROP in the single fetal group was 10.92% (39/357), which was significantly higher than 18.37% (27/147) in the multifetal group (χ2=5.069, P=0.024), and risk of ROP in the multifetal group was higher than that in the single fetal group (OR=1.835). The oxygen inhalation rate was 42.02% (150/357) and the oxygen inhalation duration was 5.71 days in the single fetal group, and that in the multifetal group was 58.50% (86/147) and 9.42 days, respectively. Conclusions Incidence and risk of ROP in the multifetal infants are higher than those in the single fetal infants, and low-birth-weight, less gestational weeks and excess oxygen inhalation are influence factors. Key words: Infant, newborn; Retinopathy of prematurity; Incidence; Single fetal newborns; Multifetal newborns; Gestational age; Birth weight; Oxygen/adverse effects

Research progress on angiopoietin-1 and retinopathy of premature

Retinopathy of premature is characterized by retinal vascular dysplasia,angiogenesis,fiber proliferation and retinal detachment,which can lead to a variety of serious complications,including permanent blindness.Angiopoietin-1,which has a close relationship with the incidence of ROP,is an important factor affecting angiogenesis.This paper will discuss the relations between angiopoietin-1 and retinopathy of premature. Key words: Retinopathy of premature; Angiogenin-1 ; Vascular endothelial growth factor; Angiopoietin-2

PS-279 Prolonged Oxidative Stress And Increased Incidence Of Neonatal Morbidities After Early Postnatal Exposure To Oxidants In Infants Less Than 29 Weeks Gestational Age: Abstract PS-279 Table 1

Background The antioxidant defenses are poorly developed in preterm infants. Oxygen and parenteral nutrition (PN) which is contaminated with peroxides are two major sources of oxidants. Objective To assess the effect of early oxygen (on day 7 and 28) and the PN duration on oxidative stress markers at 36 weeks post menstrual age (PMA) and on the incidence of neonatal morbidities. Design/methods A prospective observational study including 120 infants less than 29 weeks gestational age without major congenital anomalies. Consent for blood sample at 36 weeks PMA was obtained for 51 infants. GSH and GSSG (nmol/mg protein) were measured by capillary electrophoresis and were used for redox potential (mV) calculation using Nernst equation, and expressed as mean (± sem). BPD was defined as the need of O 2 supplement at 36 weeks PMA. ROP that required either laser or anti-VGF treatment and NEC grade 2 or higher according to Bell’s criteria were included. Student’s t test or Chi squared were used as appropriate, * = p Results FiO 2 ≥ 25% on day 7 and 28 of life and PN duration > 14 days resulted in higher GSSG concentration, more oxidised redox potential at 36 weeks PMA and increased the incidence of BPD, ROP and NEC Conclusions Early life exposure to oxidants is associated with prolonged oxidative stress and higher incidence of neonatal morbidities. These results suggest that strategies targeting judicious O 2 use and either decreasing the duration or using safer formulation PN will help decreasing the incidence of BPD, ROP and NEC.

PO-0647 To Determine The Incidence, Risk Factors And Need For Surgery For Retinopathy Of Prematurity(rop) Among Very-low-birth-weight(vlbw) Infants Weighing &lt;1500gms

Materials and methods Retrospective analysis of 12 years data, of all VLBW screened for ROP, managed by Singapore General Hospital, for maternal, neonatal risk factors using univariate and multiple logistic regressions. Results Incidence of ROP was 24.8% among all screened VLBW. By univariate analysis, maternal risk factors for severe ROP were prolonged rupture of membrane (PROM), pyrexia, multiple births, tocolysis, fetal disress and vaginal delivery. Neonatal risk factors for ROP were, infant with lower gestational age than 25± 2 weeks (mean + SD), birth weight lesser than 689 ± 147 gm (mean + SD), low Apgar scores, hyaline membrane disease (HMD) requiring surfactant, hypothermia, sepsis, hypotension, patent ductus arteriosus (PDA), air-leak, hypoglycaemia, intraventricular haemorrhage (IVH) increased days on assisted ventilation, CPAP, Oxygen and high mean FiO 2 and Chronic lung disease (CLD), are significant risk factors for ROP (p By multivariate analysis, lower GA (OR = 0.728, 95% CI = 0.609–0.870), lower BW (OR = 0.996, 95% CI = 0.994–0.997) and increased days on oxygen (OR = 1.015,95% CI = 1.006–1.025) were independent risk factor for ROP. Conclusion High risk factors for severe ROP are extreme preterm infants born vaginally to mother with infection and PROM, multiple birth, used tocolysis, fetal distress with lower GA than 25+2 weeks (mean+SD), with BW lesser than 689+147 gm mean+SD), having low 1,5 min Apgar score, HMD requiring surfactant, hypothermia, sepsis, hypotension, patent ductus arteriosus (PDA), chronic lung disease (CLD), air-leak, hypoglycaemia, intraventricular haemorrhage (IVH). Longer duration of mechanical ventilation, CPAP and oxygen with increased FIO2 due to CLD, are also higher risk of ROP. By multivariate analysis lower GA, BW and increased days on oxygen were found to be high risk factors for ROP. Prevention of extreme prematurity, maternal infection, PROM, optimal ventilator care, with careful titration of oxygen therapy which can decrease CLD may reduce the incidence and severity of ROP in these high-risk ELBW infants.

Antenatal steroid uygulamasının erken dönem prematüre sorunları üzerine etkisi

The effect of antenatal steroid on the early outcome of premature infants Objective: The aim of this study was to evaluate the effect of antenatal steroid (AS) administration on the early outcome of premature infants. Method: The data of premature infants with gestational ages ≤34 weeks who were admitted to the Neonatal Intensive Care Unit between 2008 and 2012 were analysed retrospectively. Infants with major congenital anomalies and borned out of our hospital our hospital were excluded from the study. According to the application of AS infants were divided into 3 groups: completed cure, incompleted cure and without application. The results of early period mortality and morbidity were compared between the three groups. Results: During this time period 547 infants were borned. The study was completed with 504 infants because of 17 infants have congenital abnormalities and 26 infants referred to different hospitals. In the first 28 days of life 41 (8.1%) infants died. In our study, AS application were found as 20.8% (n=105) of completed cure, 13.3% (n=67) of the incompleted cure with the total of 34.1%. In the infants who were administered completed cure AS, the mortality ratio, the incidence of proven sepsis and ROP were found low statistically (p values: 0.001, 0.02, <0.001, respectively). The length of stay at hospital was significantly higher in infants without application (p: 0.03). Conclusion: Preterm infants who applicated AS with completed cure had lower incidence of mortality, proven sepsis and ROP. On the other hand in infants without AS application had longer duration of hospitalization. In our country AS application rate is very low and development of appropriate health policies needed for the widespread use of AS.

Can Higher PEEP and FiO2 with Bubble CPAP Reduce Need for Invasive Ventilation in Preterm Babies with Respiratory Distress Syndrome?

Objectives: To evaluate the clinical course and outcome in preterm babies with RDS using higher PEEP and FiO2 as appropriate on bubble CPAP as the primary mode of respiratory support. CPAP failure and oxygen requirement by 28 days of life were primary outcome. Incidence of pneumothorax, hypotension, NEC, IVH and ROP and survival till discharge were thesecondary outcomes measured. Method: Preterm babies (gestation 26 to 36 weeks) admitted to tertiary level NICU (both inborn and outborn) with RDS were managed with bubble CPAP as a primary mode of respiratory support. Higher pressure upto 8-10 cm of water and FiO2 upto 80-100% was given (if required) during CPAP. Results: Total 73 neonates were studied, out of which 52% received antenatal steroids and 54.8% received surfactant. Overal CPAP success rate was 95.9% with success in severe, moderate and mild RDS cases 84.6%, 97.5% and 100% respectively. Among <28 week age-group, 85.7% cases were successful. Peak CPAP pressure of ≥ 8cm water was given to 21.4% babies in success group. Conclusions: Bubble CPAP may be considered as a primary mode of respiratory support in RDS even in very preterm and ELBW babies irrespective of the severity. Early CPAP and surfactant, peak pressure upto 8-10 cm H2O and FiO2 100% with trained and committed staff with 1:1 care can lead to higher success rate. CPAP is safe even in very preterm infants with RDS and associated with lesser lung injury and other complications.

Factors influencing rates of retinopathy of prematurity in Argentina: A case study of policy, legislation, and international collaboration

PurposeTo describe the processes and stakeholders, including the Ministry of Health (MOH) and UNICEF, involved in the process from the recognition of an epidemic of ROP blindness in Argentina to the development of national guidelines, policies and legislation for its control.MethodsData on the incidence of ROP was collected from 13 NICUS from 1999 until 2012, as well as the percent of children blind from ROP in 9 blind schools throughout 7 provinces in Argentina. Additionally, document reviews, focus group discussions and key informant interviews were conducted with neonatologists, ophthalmologists, neonatal nurses, MOH officials, clinical societies, legislators and UNICEF staff in the 7 provinces.ResultsIn the late 1990’s over 80% of children under 5 years old in schools for the blind were blind from ROP. Recognition of this led to the formation of a National ROP group through the MOH in 2003, a targeted intervention of workshops and capacity building with UNICEF from 2004 to 2008 and the development of a national ROP screening law in 2007. By 2012, the rates of ROP as a cause of blindness in children in blind schools and the rates of severe ROP needing treatment in the NICUs visited had decreased significantly.DiscussionThe combination of a national ROP program, collaboration with UNICEF and national legislation, played a role in decreasing ROP in 7 provinces throughout Argentina.ConclusionsThe lessons learned and successes experienced in Argentina can hopefully be replicated in other countries in Latin America and beyond. PurposeTo describe the processes and stakeholders, including the Ministry of Health (MOH) and UNICEF, involved in the process from the recognition of an epidemic of ROP blindness in Argentina to the development of national guidelines, policies and legislation for its control. To describe the processes and stakeholders, including the Ministry of Health (MOH) and UNICEF, involved in the process from the recognition of an epidemic of ROP blindness in Argentina to the development of national guidelines, policies and legislation for its control. MethodsData on the incidence of ROP was collected from 13 NICUS from 1999 until 2012, as well as the percent of children blind from ROP in 9 blind schools throughout 7 provinces in Argentina. Additionally, document reviews, focus group discussions and key informant interviews were conducted with neonatologists, ophthalmologists, neonatal nurses, MOH officials, clinical societies, legislators and UNICEF staff in the 7 provinces. Data on the incidence of ROP was collected from 13 NICUS from 1999 until 2012, as well as the percent of children blind from ROP in 9 blind schools throughout 7 provinces in Argentina. Additionally, document reviews, focus group discussions and key informant interviews were conducted with neonatologists, ophthalmologists, neonatal nurses, MOH officials, clinical societies, legislators and UNICEF staff in the 7 provinces. ResultsIn the late 1990’s over 80% of children under 5 years old in schools for the blind were blind from ROP. Recognition of this led to the formation of a National ROP group through the MOH in 2003, a targeted intervention of workshops and capacity building with UNICEF from 2004 to 2008 and the development of a national ROP screening law in 2007. By 2012, the rates of ROP as a cause of blindness in children in blind schools and the rates of severe ROP needing treatment in the NICUs visited had decreased significantly. In the late 1990’s over 80% of children under 5 years old in schools for the blind were blind from ROP. Recognition of this led to the formation of a National ROP group through the MOH in 2003, a targeted intervention of workshops and capacity building with UNICEF from 2004 to 2008 and the development of a national ROP screening law in 2007. By 2012, the rates of ROP as a cause of blindness in children in blind schools and the rates of severe ROP needing treatment in the NICUs visited had decreased significantly. DiscussionThe combination of a national ROP program, collaboration with UNICEF and national legislation, played a role in decreasing ROP in 7 provinces throughout Argentina. The combination of a national ROP program, collaboration with UNICEF and national legislation, played a role in decreasing ROP in 7 provinces throughout Argentina. ConclusionsThe lessons learned and successes experienced in Argentina can hopefully be replicated in other countries in Latin America and beyond. The lessons learned and successes experienced in Argentina can hopefully be replicated in other countries in Latin America and beyond.