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Stefan Karel De Smedt; Retinopathy of Prematurity in Rwanda: setting up a screening system.. Invest. Ophthalmol. Vis. Sci. 2018;59(9):186.
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© ARVO (1962-2015); The Authors (2016-present)
Retinopathy of Prematurity (ROP) increasingly threatens the vision of premature babies in low income countries, where ophthalmic screening has to catch up with improving neonatal care. Little is known about its incidence in sub-Saharan Africa. We introduced a ROP screening program in Rwanda with an explorative case control study nested in a prospective observational study to document ROP incidence and risk factors in the 3 major neonatal intensive care units (NICU).
All neonates admitted to the NICUs from September 2015 till July 2017 were recruited, if fulfilling the inclusion criteria (gestational age (GA) <35 weeks or birth weight (BW) <1800 grams or unstable clinical course). The incidence of mild and treatment requiring ROP (Zone I, stage 3 without plus disease or Zone I, any stage with plus disease, or Zone II, Stage 2 and 3 with plus disease) were studied. Risk factors for ROP were analyzed in univariate and multivariate logistic regression models, calculating odds ratios (OR) with 0.05 significance tests and 95% confidence intervals (CI).
Among 2240 babies admitted to the NICUs, 802 (35,8%) fulfilled the inclusion criteria, of which 424 were screened for ROP and analyzed (12 refusals, 271 deaths, 95 losses to follow-up prior to eye check). The mean GA (± standard deviation SD, range) was 31.68 weeks (SD 2.16, 24-37). The mean BW was 1480grams (SD 360, 650-2800). A total of 31 babies (7.31%, CI 5.02-10.22) developed any ROP and 14 (3.3%, CI 1.82-5.48) required treatment. ROP was seen in 6 babies with GA >30 weeks and BW >1500 grams, of which 3 required treatment. Univariate analysis identified as ROP risk factors: high oxygen (O2) supply (OR 2.20, p<0.001, CI 1.54-3.15), low BW (OR 2.25, p<0.001, CI 1.48-3.41), low GA (OR 3.41, p<0.001, CI 1.81-6.41), hyperglycemia ≥150mg/dl (OR 6.63, p<0.001, CI 2.04-21.50), blood transfusion (OR 3.04, p=0.002, CI 1.44-6.43) and sepsis (OR 3.23, p= 0.01, CI 1.20-8.66). After multivariate analysis O2 supply (OR 2.05, p=0.01, CI 1.18-3.57) and hyperglycemia (OR 3.48, p=0.05, CI 0.98-12.35) remained significant.
In Rwanda the incidence of treatment requiring ROP is in the same range as in Western literature, but ROP screening is indicated beyond the 2013 American Academy screening guidelines. Especially O2 supply and hyperglycemia deserve special attention. Further sensitization of parents and health community is important to reduce loss to follow-up.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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