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Pitfalls of Advanced Retinopathy of Prematurity Presentation: A Content Analysis of Medical Records
Lojain AlBathi1, Noura Abouammoh2, Nayef AlSwaina3
1Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Gaps in retinopathy of prematurity (ROP) screening, including physician inadequacy and unavailability, lead to advanced disease in Saudi Arabia. Improving ROP screening networks is crucial for timely intervention.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in premature infants.
- Effective screening protocols are essential to prevent severe visual outcomes.
Purpose of the Study:
- To identify critical failures in retinopathy of prematurity (ROP) screening processes.
- To understand the reasons for advanced ROP cases in Ministry of Health (MOH) hospitals in Saudi Arabia.
Main Methods:
- Qualitative deductive content analysis of ROP screening defects.
- Retrospective review of medical records of 29 infants with advanced ROP (stage 4-5).
- Analysis of data using a pre-structured categorization matrix.
Main Results:
- Only 13 of 29 identified medical records were available for review.
- Identified screening pitfalls include: failure to refer, delayed/failed follow-up by ophthalmologists, diagnostic errors, poor documentation, physician unavailability, family negligence, and delayed referrals.
- Disease progression occurred despite some timely screening efforts.
Conclusions:
- Implementation of available ROP screening guidelines is suboptimal.
- Physician inadequacy and unavailability are the most common screening defects.
- Establishment of a competent ROP screening physician network and specialized surgical centers is recommended.
Purpose:
To identify the pitfalls in retinopathy of prematurity (ROP) screening leading to advanced disease at Ministry of Health (MOH) hospitals in Saudi Arabia.
Methods:
A qualitative deductive content analysis was used to study the phenomena of defects in ROP screening. A retrospective review of medical records of newborns presenting to two tertiary eye care centers with advanced ROP (stage 4 and 5) from January 2012 to June 2019 was completed. An extensive review of the original files at the referring hospitals was conducted, including the general condition and findings of ophthalmic examination and the sequence of follow-up until the infant was discharged/referred. Data analysis was completed using pre-structured categorization matrix.
Results:
Records of 29 infants with advanced stage ROP were identified. Only 13 medical records were available and obtained. The pitfalls in screening found in the study were failure to refer by the neonatologist, delayed follow-up by the ophthalmologist, failure to follow-up by the ophthalmologist, failure to diagnose by the ophthalmologist, poor documentation in patient files, unavailability of ophthalmologist, family negligence, lack of treatment and delayed referral to a higher center, and progression despite timely screening and management.
Conclusion:
Although clear ROP screening guidelines are available, implementations of these guidelines are suboptimal. This study showed that the most common defect in screening is physician's inadequacy and unavailability. A proper network of competent ROP screening physicians in all neonatal intensive care units should be established. Centers for advanced ROP surgery should be allocated to deliver a timely surgical care if needed.
