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Retinopathy of prematurity in Rwanda: a prospective multi-centre study following introduction of screening and
Francis Mutangana1, Charles Muhizi2, Godelieve Mudereva3
1Ophthalmology, King Faisal Hospital, Kigali, Rwanda.
Insights
Risk factors for retinopathy of prematurity (ROP) in Rwanda include prolonged oxygen use and hyperglycemia. These findings highlight the need for improved neonatal care and adjusted screening guidelines to address this emerging health issue.
Area of Science:
- Neonatal ophthalmology
- Public health
- Perinatal medicine
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Established ROP screening programs are crucial for early detection and intervention.
- The epidemiology and risk factors for ROP in African populations require further investigation.
Purpose of the Study:
- To identify risk factors associated with retinopathy of prematurity (ROP) in a newly established screening and management program in Rwanda.
- To evaluate the incidence of ROP and treatment-warranted ROP within this specific population.
- To inform the development of targeted interventions and improved neonatal care practices.
Main Methods:
- A multi-center prospective study involving 795 eligible infants (gestational age < 35 weeks or birth weight < 1800g).
- ROP screening was conducted on 424 infants, with classification based on the revised International Classification of ROP (2005).
- Maternal and perinatal risk factors were collected from neonatal records, with univariate and multivariate analyses performed.
Main Results:
- Any ROP developed in 7.3% of screened infants, with 41.9% requiring treatment.
- Significant risk factors identified in univariate analysis included increased supplemental oxygen duration, low gestational age, low birth weight, hyperglycemia, blood transfusion, and sepsis.
- Multivariate analysis confirmed longer exposure to supplemental oxygen and hyperglycemia as significant independent risk factors for ROP.
Conclusions:
- Retinopathy of prematurity (ROP) is an emerging health concern in Rwanda, necessitating dedicated screening and treatment programs.
- Current ROP screening guidelines may need to be adapted for the Rwandan context, potentially screening infants beyond the 2013 American Academy guidelines.
- Enhancing the quality of neonatal care, particularly in oxygen administration and monitoring, is critical to reduce the incidence and severity of ROP.
Objectives:
To investigate risk factors for retinopathy of prematurity (ROP) in a newly established ROP screening and management programme in Rwanda, Africa.
Methods:
In this multi-centre prospective study 795/2222 (36%) babies fulfilled the inclusion criteria (gestational age (GA) < 35 weeks or birth weight (BW) < 1800 g or unstable clinical course), 424 (53%) of whom were screened for ROP. 270 died before the first screening. ROP and treatment-warranted ROP were classified using the revised International Classification of ROP (2005). Data on maternal and perinatal risk factors were collected from daily neonatal notes.
Results:
31 babies (7.3%, CI 5.0-10.2) developed any ROP, 13 of whom (41.9%, CI 24.5-60.9) required treatment. ROP was seen in six neonates with GA > 30 weeks and BW > 1500 g, one of whom required treatment. In univariate analysis the following were associated with any ROP: increasing number of days on supplemental oxygen (OR 2.1, CI 1.5-3.0, P < 0.001), low GA (OR 3.4, CI 1.8-6.4, P < 0.001), low BW (OR 2.3, CI 1.5-3.4, P < 0.001), at least one episode of hyperglycaemia ≥ 150 mg/dl (OR 6.6, CI 2.0-21.5, P < 0.001), blood transfusion (OR 3.5, CI 1.6-7.4, P < 0.001) or sepsis (OR 3.2, CI 1.2-8.6, P = 0.01). In multivariate analysis longer exposure to supplemental oxygen (OR 2.1, CI 1.2-3.6, P = 0.01) and hyperglycaemia (OR 3.5, CI 1.0-12.4, P = 0.05) remained significant.
Conclusions:
ROP has become an emerging health problem in Rwanda, requiring programmes for screening and treatment. ROP screening is indicated beyond the 2013 American Academy guidelines. Improved quality of neonatal care, particularly oxygen delivery and monitoring is needed.
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