First Author: N.Prabhudesai INDIA
Co Author(s): M. Prabhudesai D. Muzumdar S. Nagpal
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Although there is a growing awareness not all Neonatal Intensive Care Units (NICU)have strict management protocols as some recent reports from India suggest. Also many may be unable to form a liaison with ophthalmologist for a effective screening programme. In our Institute, having a level three NICU, we have been conducting a strict protocol based screening programme for ROP. We decided to study and analyse our data for incidence and severity of ROP, its correlation with risk factors, like birth weight and gestational age, with special reference to oxygen saturation protocols being practised in our NICU.
Medical college hospital, Institutional, observational study, analysis of data collected over period of 2 yrs, from June 2014 to June 2016.
This study was carried out at a level 3 NICU at a tertiary care hospital. National neonatology forum guidelines were followed in the screening programme. The O2 saturation protocols followed in our NICU, were based on BOOST trails (I,II). First screening by Indirect ophthalmoscopy was performed between 3rd and 4th week after birth by trained ophthalmologist. Babies were examined in the nursery, with pupils dilated with 2.5% tropicamide and 2.5% phenylephrine drops. Treatment was based on revised ETROP guidelines. All babies were followed up, up to 6 months of age. Data regarding birth weight, gestational age, oxygen saturation profile, the stage and zone of ROP, its management and treatment outcomes, were noted. Data was subjected to analysis using Fischer exact T test.
A total of 416 babies were screened. Males were 132 and females 284. Incidence of ROP was found to be 3.3% (14). Out of 24 affected eyes, 41.6% (10) had stage I ROP, 50% (12) had stage II ROP, 8.3% (2) had stage III ROP. Plus disease was seen in 2 eyes. 37.5% (9) eyes showed zone II involvement,,62.5% (15) zone III involvement. 14.2% (2) had Type 1 ROP and were treated with laser photocoagulation and 85.8% (12) had Type 2 ROP and were observed. Complete regression was noted in all the cases. Babies with Birth Weight (BW)of < 1250 grams showed ROP incidence of 6.03% ,BW between 1250 to 1500 grams had ROP incidence of 0.9 % ,and those with BW >1500 gms it was 0% , ( p value < 0.001).Babies with Gestational Age(GA) < 28 weeks showed ROP incidence of 36.3%,those between 28-34 weeks showed incidence of 5% and those between 32-34 weeks was 0.8%. p-value (< 0.001). Infants having received oxygen saturation level between 85-90%, 15.3 % developed ROP. Oxygen saturation levels of 90-92% and 92-95% showed ROP incidence of 3.48 % and 1.3 % respectively. p value ( 0.096) was not significant.
In our study we report an incidence of 3.3% which is strikingly less than that reported by most Indian studies where incidence ranges from 11% to 44%. We also observed that the severity of ROP was also less , with maximum cases showing involvement only upto zone 2 stage 3,and only 0.4% required treatment. This is in stark contrast to many reports from India where Zone 1 disease has high incidence. We found a positive correlation of incidence of ROP as related to birth weight and GA which is in accordance to most of the studies. We observed a positive co-relation between supplemental oxygen therapy and incidence of ROP although it was not statistically significant. The severity of ROP observed in lower GA babies receiving titrated oxygen (80-85%), was certainly less. The protocols being followed seem to have overall reduced the incidence and severity of disease. We thus believe that strict protocol based NICU care and a well coordinated liaison with ophthalmic department can significantly lower the incidence and severity of ROP.