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Influence of Anaemia on Multifactorial Disease Retinopathy of Prematurity: A Prospective Observational Study
Manish Tandon1, Raksha Ranjan2, Uma Muralidharan3
1Ophthalmology, United Institute of Medical Sciences, Prayagraj, IND.
Insights
Anemia is a significant risk factor for retinopathy of prematurity (ROP) in preterm newborns and should be corrected. Early ROP stages often regress spontaneously, while later stages may require treatment.
Area of Science:
- Neonatal Ophthalmology
- Perinatal Medicine
- Pediatric Critical Care
Background:
- Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness.
- It is a serious complication in preterm (PT) infants requiring medical treatment.
- Identifying risk factors is crucial for preventing ROP development and progression.
Purpose of the Study:
- To analyze risk factors (RF) associated with ROP development and progression.
- To specifically investigate the contribution of anemia to ROP.
- To evaluate the relationship between gestational age, birth weight, and ROP.
Main Methods:
- Prospective observational study conducted over 12 months.
- Included neonates with gestational age (GA) ≤ 35 weeks or birth weight (BW) ≤ 2 kg.
- Assessed gestational, perinatal, and postnatal RFs, including hemoglobin (Hb) and hematocrit (Hct) levels.
Main Results:
- ROP incidence in the study was 46.7%, higher than previously reported in India.
- GA and BW were significantly associated with ROP incidence.
- Anemia showed a significant association with ROP incidence, though not as an independent RF.
- Early ROP stages (1-2) had higher spontaneous regression rates than advanced stages (3-4).
Conclusions:
- Anemia is an avoidable risk factor for ROP and should be corrected in preterm infants.
- ROP screening is recommended for preterm infants with GA < 35 weeks or BW < 2 kg presenting with risk factors.
- Further randomized trials are needed to clarify the association between anemia and ROP due to the study's small sample size.
Background:
Retinopathy of prematurity (ROP), a preventable cause of childhood blindness, is a severe complication of preterm (PT) birth treatment.
Purpose:
The purpose of this study is to analyse the risk factors (RF) associated with the development and progression of ROP. Particular focus is on the contribution of anaemia towards the development and progression of ROP.
Methods:
This study is a prospective observational study done in the Department of Paediatrics at Meenakshi Mission Hospital & Research Centre, Madurai, over 12 months from May 2013 to April 2014. The study included all consecutively admitted neonates born in and out of the hospital with gestational age (GA) less than or equal to 35 weeks or birth weight (BW) less than or equal to 2 kg and assessed for the gestational, perinatal, and postnatal RF. In addition, at the time of ROP screening, haemoglobin (Hb) and haematocrit (Hct) were checked. The statistical analysis was performed by Stata 11.1 (StataCorp LLC, College Station, TX).
Result:
The incidence of ROP in our study (46.7%) is higher than previously reported in India. In our study, GA and weight of the neonate at birth have a significant association with ROP incidence. Anaemia in our study is significantly associated with ROP incidence but not as an independent RF. The outcome of various stages of ROP is statistically significant, showing early stages 1 and 2 have more chances of spontaneous regression, and stages 3 and 4 are more likely to need treatment. Two cases in our study with stage 4 ROP had no complications, and none had stage 5 disease.
Conclusion:
Anaemia should be avoided or corrected in PT newborns as it is a potential and avoidable RF for ROP development. The limitation of our study is the small sample size, and probably more extensive randomized trials will help make this association clear. We recommend ROP screening for PT babies with GA less than 35 weeks and BW less than 2 kg who have the RF amounting to screening and done as per protocol.
