Abstract
Objective
To evaluate the risk factors predisposing to severe retinopathy of prematurity (ROP) in a level III neonatal unit. This retrospective study was conducted in a tertiary care neonatal and ophthalmic center.
Methods
The authors retrospectively analyzed data of preterm infants who were born from January 2003 through December 2008 and were screened for ROP. Data were collected from prospectively filled ROP screening forms. All the neonates with gestation ≤ 32 wks or birth weight ≤1500 g were screened. In addition, infants with birth weight of 1501–1800 g or gestation of 33–34 wks were also screened in the presence of additional risk factors like need for oxygen or mechanical ventilation. Primary outcome was severe ROP defined as treatable ROP as per type I ETROP guidelines (after year 2005) or threshold disease (before 2005).
Results
A total of 704 neonates were screened during the study period, of whom 84 (11.9%) and 33 (4.7%) infants developed any ROP and severe ROP, respectively. The mean birth weight and gestation of infants with severe ROP were 1113 ±438 g and 29 ± 3 wks, respectively. The following risk factors were found to be significant for severe ROP on univariate analysis: gestation ≤ 30 wks, birth weight <1000 g, respiratory distress syndrome, use of surfactant, apnea, hypotension, patent ductus arteriosus (PDA), sepsis, necrotizing enterocolitis, pneumonia, meningitis, intraventricular hemorrhage, packed cell transfusion, and use of oxygen, continuous positive airway pressure and positive pressure ventilation. On multivariate analysis by stepwise logistic regression, respiratory distress syndrome (adjusted OR: 8.1 (95% CI 2.6–25.1); p < 0.001), PDA requiring medical or surgical management (adjusted OR: 3.2 (95% CI 1.1–8.9); p = 0.03), and meningitis (adjusted OR: 6.7 (95% CI 1.9–23.0); p = 0.002) were found to be independently associated with severe ROP. All infants with severe ROP had regression of the disease after laser therapy.
Conclusions
Respiratory distress syndrome, PDA requiring medical or surgical management and meningitis were found to be associated with severe ROP. Outcomes were good after laser therapy with all followed-up infants having regression of the disease.
Similar content being viewed by others
References
Phan MH, Nguyen PN, Reynolds JD. Incidence and severity of Retinopathy of Prematurity in Vietnam, a developing middle-income country. J Pediatr Ophthalmol Strabismus. 2003;40:208–12.
Flynn JT. Retinopathy of prematurity. Pediatr Clin N Am. 1987;34:1487–516.
Chawla D, Agarwal R, Deorari AK, Paul VK. Retinopathy of prematurity. Indian J Pediatr. 2008;75:73–6.
American Academy of Pediatrics, Section on Ophthalmology, American Academy of Ophthalmology, American Association of Pediatric Ophthalmology and Strabismus. Screening examination of premature infants for retinopathy of prematurity. Pediatrics. 2006;117:572–6.
Early Treatment for Retinopathy of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: results of the early treatment for retinopathy of prematurity randomized trial. Arch Ophthalmol. 2003;121:1684–94.
Chaudhari S, Patwardhan V, Vaidya U, Kadam S, Kamat A. Retinopathy of Prematurity in a Tertiary Care Center –Incidence, Risk Factors and Outcome. Indian Pediatr. 2009;46:219–24.
Rekha S, Battu RR. Retinopathy of prematurity: incidence and risk factors. Indian Pediatr. 1996;33:999–1003.
Charan R, Dogra MR, Gupta A, Narang A. The incidence of retinopathy of prematurity in a neonatal care unit. Indian J Ophthalmol. 1995;43:123–6.
Sasidharan CK, Kumar MS, Anoop P, Syamala B, Das BN. Spontaneous regression of retinopathy of prematurity. Indian J Pediatr. 2003;70:359–60.
Bourla DH, Gonzales CR, Valijan S, Yu F, Mango CW, Schwartz SD. Association of systemic risk factors with the progression of laser-treated retinopathy of prematurity to retinal detachment. Retina. 2008;28:S58–64.
Gupta VP, Dhaliwal U, Sharma R, Gupta P, Rohatgi J. Retinopathy of prematurity-risk factors. Indian J Pediatr. 2004;71:887–92.
Martin CG, Snider AR, Katz SM, et al. Abnormal cerebral blood flow patterns in preterm infants with a large patent ductus arteriosus. J Pediatr. 1982;101:587–93.
Flower RW, Blake DA, Wajer SD, et al. Retrolental fibroplasia: Evidence for a role of the prostaglandin cascade in the pathogenesis of oxygen induced retinopathy in the newborn beagle. Pediat Res. 1981;15:1293–302.
Nair PM, Ganesh A, Mitra S, Ganguly SS. Retinopathy of prematurity in VLBW and extreme LBW babies. Indian J Pediatr. 2003;70:303–6.
Shah PK, Narendran V, Kalpana N, Gilbert C. Severe retinopathy of prematurity in big babies in India: history repeating itself? Indian J Pediatr. 2009;76:801–4.
Azad R, Chandra P, Patwardhan SD, Gupta A. Importance of the 'third criterion' for retinopathy of prematurity screening in developing countries. J Pediatr Ophthalmol Strabismus. 2009;46:332–4.
Azad RV, Manjunatha NP, Pal N, Deorari AK. Retinopathy of prematurity screening by non-retinologists. Indian J Pediatr. 2006;73:515–8.
Conflict of Interest
None.
Role of Funding Source
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kumar, P., Sankar, M.J., Deorari, A. et al. Risk Factors for Severe Retinopathy of Prematurity in Preterm Low Birth Weight Neonates. Indian J Pediatr 78, 812–816 (2011). https://doi.org/10.1007/s12098-011-0363-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12098-011-0363-7