Dr.Harika Velumani, Dr.Mary Santhosh,Dr.Muthayya Muthukumar
INTRODUCTION
- Retinopathy of prematurity(ROP) is a blinding morbidity affecting preterm infants and represents the leading preventable cause of childhood blindness worldwide.
- Pathogenic pathway is characterized by abnormal retinal vascular development modulated by vascular growth factors: low IGF-1 and high VEGF.
- The emergence of ROP depends on the interaction of multiple factors which if remain unrecognized and untreated can cause severe visual impairment and blindness.
AIM OF THE STUDY
- To evaluate the following conditions as risk factors for retinopathy of prematurity.
- Failure to gain weight during the first 4 weeks of life
- Hyperglycaemia in perinatal period
- Haemoglobin levels (less than 12gm%) within 72hours after birth.
- Post natal sepsis
MATERIALS AND METHODS
- The study was done as a case control study and the data was collected from records maintained in the Medical Records Department of SRMC.
- All the babies admitted in the NICU of SRMC who are less than 32 weeks of gestational age and 1.5kg birth weight or those babies who are deemed to have high risk due to stormy perinatal period have been referred to the department of ophthalmology by the neonatologist.
All those babies have been subjected to ophthalmologic examination at a chronological age of 3-4 weeks and follow up was done biweekly, weekly, once in 2 weeks or once in 3 weeks based on the severity of ROP detected.
- They have been followed up till the retinal vascularization is complete or till ROP regresses spontaneously or when treated with laser.Birth weight
- Weight gain during the first four weeks of life
- Hb levels within 72hrs of birth
- Glycemic status(at birth)
- Apnoea attacks
- Blood transfusion
- Sepsis
- Oxygen administered
- Number of days on ventilator
- Number of days on CPAP
- Highest PO2
- Records of 1298 babies ( 360 babies with ROP and 938 records of babies who did not develop ROP during the follow up) from January 2014 to December 2016 were evaluated.
- Based on the above records all the babies who were diagnosed to have ROP were selected as cases for the study.
- ROP was diagnosed by fundus examination using indirect ophthalmoscope and were graded based on the ICROP classification.
- Exclusion Criteria:
- Babies with severe congenital anomalies
STATISTICS
- Individual proforma was used for extraction of data from the records and excel spreadsheet was used for data entry.
- SPSS statistcial software version 16 was used for data analysis.
RESULTS
- Of the 1298 babies evaluated, 360 babies (28%) had ROP and 938 babies did not develop ROP.
- Failure to gain weight had the highest statistical significance with 95%Confidence Interval(CI) [4.5-7.9] with P = 0.0001.
- Reduced Hb levels with 95% CI [2.9-4.9] with P = 0.0001.
- Hyperglycemia with 95%CI [3.8-6.6] with P= 0.0001.
- Sepsis with 95%CI [1.6-2.6] with P= 0.0001
DISCUSSION
- In this case control study , 1298 preterm babies were studied who were selected according to the relevant criteria.
- 28% of the babies developed ROP .
- Average gestational age was 30.2 ± 4weeks, of which the youngest child was at GA of 26 weeks and the oldest at 37 weeks of gestation.
- Average BW was 1767.5 ± 320 grams with lowest weight at 685grams and highest was 2850 grams.Of the 360 babies diagnosed with ROP ,stage 1-2 was found in 168 babies
- Stage 3 was found in 187 babies
- Stage 4 was found in 4 babies
- Stage 5 in 1 baby
- Laser was given for 57 babies
- Enomoto H at all. found in clinical records of 143 new born infants with gestational age of 32 weeks or less were reviewed .
- Severe ROP was diagnosed when photocoagulation due to progression to stage 3 was identified or when ‘plus disease’ developed
- Thomas K.at all. In their study on 9187 children found that 1163 (12.7%) infants developed severe ROP .
- Lower gestational age, male sex , small for gestational age , PDA, late onset sepsis ,more than 2 blood transfusions , use of inotropes were associated with an increase risk of severe ROP
CONCLUSION
- Prevention by reduction of risk factors that disrupt normal retinal vascularization is likely to be more effective than late treatment of neovascularization.
- Babies who are in zone 1 developed reactive form of ROP, were born at the earlier gestational age with LBW, low APGAR score.
- This study showed that failure to gain weight, hyperglycemia, low Hb levels and sepsis are independent risk factors in the development of ROP.
- Early identification of risk factors and the institution of appropriate treatment offer the baby a better overall development and prevent or delay the development of ROP.
REFERENCES
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