Retinopathy of Prematurity in a rural Neonatal Intensive Care Unit in South India--a prospective study

To report the incidence, spectrum and treatment outcome of Retinopathy of Prematurity (ROP) in a rural neonatal nursery.

This Prospective, observational, non-randomized study was conducted in a level III Neonatal Intensive Care Unit (NICU) at district headquarters in South India. 118 babies with birth weight ≤2000 g and/or period of gestation (POG) ≤34 wk were included in the study. Eligible infants were screened with indirect ophthalmoscopy and wide-field digital imaging (Retcam) until retinal vascularization was complete or disease regressed. Early Treatment Retinopathy of Prematurity (ETROP) guidelines were followed for laser.

The overall incidence of ROP was 41.5% and treatable ROP was 26.4% (24/91) of eyes diagnosed with ROP and 10.2% (24/236) of the overall eyes screened. The mean birth weights and periods of gestation with and without ROP were 1555.9 vs. 1672.5 g (P 0.005) and 32.2 vs. 34.6 wk, respectively (P<0.001). Half of the treated eyes had aggressive posterior ROP in Zone 1. All treated eyes had a favorable outcome. Respiratory distress syndrome, oxygen therapy, neonatal Jaundice and sepsis were higher in the ROP group but was not statistically significant. Of the overall infants screened, 68 (57.6%) were heavier and older than the American screening cut-off. Of these, 36.8% had some stage ROP and 8% required treatment.

This is the first prospective ROP study from a district NICU in India and compares with previously published urban data. If Western-screening guidelines are used in the rural scenario, we risk a significant proportion of infants being missed who may require treatment.