Related Experiment Video
Updated: Jul 17, 2026
Oxygen-Induced Retinopathy Model for Ischemic Retinal Diseases in Rodents
Published on: September 16, 2020
How to prevent ROP in preterm infants in Indonesia?
Johanes Edy Siswanto1,2, Peter H Dijk3, Arend F Bos3
1Neonatology Working Group, Department of Pediatrics Harapan Kita Women and Children Hospital Jakarta Indonesia.
Insights
Preventing retinopathy of prematurity (ROP) in preterm infants requires strict oxygen regulation and timely screening. Implementing standard practices like "STOP - R1O2P3" can reduce ROP incidence in low-middle income countries.
Area of Science:
- Neonatology
- Ophthalmology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a severe eye disease affecting preterm infants, disproportionately impacting Low-Middle Income Countries (LMIC).
- Key risk factors include extreme prematurity, oxygen use, infections, respiratory issues, poor nutrition, and blood transfusions.
Purpose of the Study:
- To provide an overview of ROP prevention strategies for LMIC.
- To establish guidelines for ROP screening and treatment in these regions.
Main Methods:
- Literature review and data analysis from Indonesian studies.
- Development of evidence-based guidelines for ROP prevention, screening, and treatment.
Main Results:
- Prevention begins prenatally with managing preterm labor and administering corticosteroids. Newborn resuscitation should use room air or limited oxygen (30% for <29-32 weeks).
- Continuous positive airway pressure (CPAP) and minimally invasive surfactant administration are recommended. Strict oxygen monitoring (91-95% saturation) and infection prevention are crucial.
- Early nutrition (preferably mother's milk) and minimizing blood draws for transfusions are advised.
Conclusions:
- Optimal care in specialized facilities is essential for preterm infants. Strict oxygen regulation and mandatory ROP screening for infants born <34 weeks or receiving prolonged oxygen are necessary.
- Immediate treatment for ROP progression is required. A standardized approach, such as the "STOP - R1O2P3" acronym, can improve ROP prevention and management in LMIC neonatal intensive care units.
Background And Aims:
Retinopathy of prematurity (ROP) is a severe disease in preterm infants. It is seen more frequently in Low-Middle Income Countries (LMIC) like Indonesia compared to High-Income Countries (HIC). Risk factors for ROP development are -extreme- preterm birth, use of oxygen, neonatal infections, respiratory problems, inadequate nutrition, and blood and exchange transfusions. In this paper, we give an overview of steps that can be taken in LMIC to prevent ROP and provide guidelines for screening and treating ROP.
Methods:
Based on the literature search and data obtained by us in Indonesia's studies, we propose guidelines for the prevention, screening, and treatment of ROP in preterm infants in LMIC.
Results:
Prevention of ROP starts before birth with preventing preterm labor, transferring a mother who might deliver <32 weeks to a perinatal center and giving corticosteroids to mothers that might deliver <34 weeks. Newborn resuscitation must be done using room air or, in the case of very preterm infants (<29-32 weeks) by using 30% oxygen. Respiratory problems must be prevented by starting continuous positive airway pressure (CPAP) in all preterm infants <32 weeks and in case of respiratory problems in more mature infants. If needed, the surfactant should be given in a minimally invasive manner, as ROP's lower incidence was found using this technique. The use of oxygen must be strictly regulated with a saturation monitor of 91-95%. Infections must be prevented as much as possible. Both oral and parenteral nutrition should be started in all preterm infants on day one of life with preferably mothers' milk. Blood transfusions can be prevented by reducing the amount of blood needed for laboratory analysis.
Discussion:
Preterm babies should be born in facilities able to care for them optimally. The use of oxygen must be strictly regulated. ROP screening is mandatory in infants born <34 weeks, and infants who received supplemental oxygen for a prolonged period. In case of progression of ROP, immediate mandatory treatment is required.
Conclusion:
Concerted action is needed to reduce the incidence of ROP in LMIC. "STOP - R1O2P3" is an acronym that can help implement standard practices in all neonatal intensive care units in LMIC to prevent development and progression.
Related Concept Videos
01:19Depolarizing Blockers: Pharmocokinetics
01:29Local Anesthetics: Clinical Application as Epidural Anesthesia
Since epidural anesthetics can be infused through an epidural catheter, all types of drugs, including short-acting ones, can be administered. Chloroprocaine and lidocaine are examples of short and long-duration anesthetics, respectively. Bupivacaine...
01:16Local Anesthetics: Clinical Application as Intravenous Regional Anesthesia
One of the advantages of...
01:24Parenteral Anesthetics: Overview