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Surviving Extremely Low Birth Weight Infants Have a Higher Risk of ROP in Sub-Saharan Africa
Tshilidzi van der Lecq1, Gerd Holmström2, Esmè Jordaan3,4
1Department of Surgery, Division of Ophthalmology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Insights
Lower birth weight is a significant risk factor for retinopathy of prematurity (ROP) in preterm infants. Infants weighing less than 1000g are particularly vulnerable, highlighting the need for targeted neonatal care in Sub-Saharan Africa.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants.
- Risk factors for ROP have been studied globally, but not in Sub-Saharan Africa (SSA).
- Improved neonatal care in SSA is increasing survival rates of at-risk preterm infants.
Purpose of the Study:
- To investigate the risk factors for ROP in a South African population.
- To address the lack of ROP studies in Sub-Saharan Africa.
Main Methods:
- Population-based study in Cape Town, South Africa (May 2022 - January 2023).
- Included infants with birth weight < 1250g or gestational age < 32 weeks.
- Data extracted from the Retinopathy of Prematurity South African register.
Main Results:
- 378 infants were screened; 115 (30.4%) developed ROP.
- Lower birth weight was an independent ROP risk factor (OR 1.3).
- Surgical necrotising enterocolitis (NEC) was another independent ROP risk factor (OR 5.8).
- Infants < 1000g were more likely to develop ROP (OR 2.4).
Conclusions:
- Birth weight remains a significant ROP risk factor, especially for infants < 1000g.
- These low birth weight infants constitute a substantial proportion of screened infants in this SSA region.
- Findings underscore the importance of ROP surveillance in preterm infants in SSA.
Aim:
Retinopathy of prematurity (ROP) risk factors have been investigated in population-based studies from most global regions. No such studies are available from Sub-Saharan Africa (SSA), where improved neonatal care is increasing the survival of preterm infants at risk of ROP.
Methods:
A population-based study was conducted in infants born in Cape Town, South Africa, from 1 May 2022 to 31 January 2023. The screening criteria were birth weight < 1250 g or gestational age < 32 weeks. The data were extracted from the Retinopathy of Prematurity South African register.
Results:
The study included 378 screened infants, 115 (30.4%) of whom developed ROP. In the multiple regression analyses, lower birth weight was an independent ROP risk factor, OR 1.3 95% CI 1.2-1.5, p < 0.001. Surgical necrotising enterocolitis (NEC) was the only other independent ROP risk factor, OR 5.8 95% CI 1.6-21.0, p = 0.007. Infants with birth weight < 1000 g were 39.4% (130/378) of those screened and more likely to develop ROP compared to larger infants, OR 2.4 95% CI 1.5-3.9, p < 0.001.
Conclusion:
Birth weight remained a significant ROP risk factor, especially for those born weighing less than 1000 g. These infants represented a larger proportion of screened infants compared to previous Sub-Saharan African studies.
