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Abstract
Retinopathy of prematurity continues to be an important problem in premature infants despite improved facilities of care, monitoring and treatment. The etiology of ROP is still unknown but large number of factors are suggested to be involved in the development of the disease and thought to be of multifactorial origin of which oxygen is one factor.
This study presents the incidence and some possible risk factors for ROP development. The study population consisted of all preterm babies admitted to (NICUs) in Ain Shams University hospitals, from December 2006 to April 2007 with body weight less than 1500 gm and gestational age equal to or less 32 weeks or infants with GA between 32-34 weeks with unstable clinical course.
The results showed that:
* The incidence of ROP:
For all VLBW infants, retinopathy of prematurity changes were found in 53 out of 115 infants and the incidence was 46 %.
* The stages of ROP:
According to international classification of ROP there are 5 stages of the disease, only three stages were found in our study, stage I, stage II and stage III. 22 cases presented with stage I (41,4%), 22 cases with stage II (41,5%) and 9 cases with stage III (17%).
* Outcome of ROP:
For all VLBW infants with +ve ROP (53), 48 infants showed spontaneous regression (89.4%) and 5 infants showed progression (10.4%) and needed surgical intervention.
* The birth weight:
The mean birth was 1290+120 gm for infants with ROP while it was 1410+140 gm for infants without ROP. There was highly significant association between ROP and birth weight. Obviously, the smaller birth weight infants, the higher risk for ROP.
* Gestational age:
The mean gestational was 30,49+1,43 wks in infants with ROP while it was 31,04+1,58wks for infants without ROP. There was a highly significant association between ROP and gestational age. Obviously, the more immature infants, the higher risk for ROP.
* Additional risk factors:
? Sepsis, ICH, RDS, NEC, PDA, Anemia, frequency of blood transfusion(>2time) and Duration of phototherapy, duration of oxygen exposure and mean FIO2: univariate analysis of the association between these risk factors and ROP. Revealed significant association.
? Acidosis, Obstetric Problems, Need for Resuscitation, Single Need for Blood Transfusion or Phototherapy: univariate analysis of these risk factors and ROP development. Revealed no significant association.
On using stepwise multi regression discriminative analysis, It was found that birth weight less than 1360gm, the presence of sepsis, duration of oxygen therapy < 9 day, and mean FIO2 < 70% are sensitive predictor for ROP.
* Oxygen supplementation:
The result of this study showed that: mean FIO2 of mechanical ventilation, duration, FIO2 and mean PEEP of CPAP and duration and oxygen flow rate of nasal pronges were significantly associated with ROP.
CONCLUSIONS
Retinopathy of prematurely is a disease of developing blood vessels. The degree of ocular immaturity is the main predictive factor for ROP development.
The incidence of ROP reported in the current study among VLBW infants was 46 % with grades I to III severity and fortunately 89.4 % complete regression .
Analysis of the risk factors for ROP would help to understand and predict its development in high-risk neonates. ROP was found strongly associated with smaller, more immature and sicker infants (Infants <30 weeks GA and/or infant with BW <1000 g).
Sepsis, ICH, RDS, NEC, PDA, Anemia, frequency of blood transfusion (>2time), Duration of phototherapy, duration of oxygen exposure and mean FIO2 often parallel to ROP.
Acidosis, Obstetric Problems, Need for Resuscitation, Single Need for Blood Transfusion or Phototherapy not associated with ROP.
Longer duration of mechanical ventilation and oxygen supplementation with high mean FIO2 are at considerable risk for ROP.