Incidence and risk factors of retinopathy of prematurity in Goa, India: a report from tertiary care centre
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International Journal of Contemporary Pediatrics
Kossambe S et al. Int J Contemp Pediatr. 2019 May;6(3):1228-1234
http://www.ijpediatrics.com pISSN 2349-3283 | eISSN 2349-3291
DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20192017
Original Research Article
Incidence and risk factors of retinopathy of prematurity in Goa, India:
a report from tertiary care centre
Sarvesh Kossambe, Shilpa Joglekar, Annely D’Lima*, M. P. Silveira
Department of Pediatrics, Goa Medical College, Goa, India
Received: 13 February 2019
Accepted: 08 March 2019
*Correspondence:
Dr. Annely D’Lima,
E-mail: annelydlima@yahoo.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
ABSTRACT
Background: To report the incidence and risk factors leading to the development of retinopathy of prematurity
(ROP) from a tertiary care center in the western Indian state of Goa, India.
Methods: This was a prospective observational study carried out in a level II neonatal intensive care unit (NICU) for
a period of 18 months. Babies born at < 34 weeks’ gestation and having a birth weight ofKossambe S et al. Int J Contemp Pediatr. 2019 May;6(3):1228-1234
either laser photocoagulation or intravitreal anti-VEGF Parameters recorded at the time of study enrollment were
injections.9 gestational age, gender, birth weight, maternal
complications, APGAR score at birth, fetal distress,
The incidence of ROP in India has been reported over the respiratory distress syndrome (RDS), and congenital
past 2 decades, with a reducing trend in the incidence malformations detected at birth. Oxygen administration
across India. The reported incidence in India varies was performed via hood, CPAP or intubation as required
between 38%-51.9% among premature and low birth- and continuous monitoring of oxygen saturation (SpO2)
weight babies.10-12 In addition to low birth weight and was done by a pulse oximeter. Details of oxygen
gestational age, other risk factors implicated for the administration immediately after birth or anytime during
development of ROP include a high concentration of the NICU stay were also recorded. Additionally, the
oxygen therapy, respiratory distress syndrome, apnea, partial pressure of oxygen (PaO2) and partial pressure of
sepsis, blood transfusions, and anemia.13,14 carbon dioxide (PaCO2) were also measured using arterial
blood gas estimation.
This study was conducted at a level II NICU in a tertiary
care center which is a part of a large multispecialty Statistical analysis
government general hospital. Here, all preterm babies are
routinely screened for the presence of ROP. Although Considering an incidence of 19.7% obtained from our
there are well-documented studies on the incidence of prior pilot study, the total sample size required for the
ROP from northern, eastern and southern India, there is study was 240 babies. Data were analyzed with a
scant data from western India. Specifically, there is no computerized statistical package for social sciences 19
data on the incidence of ROP from Goa. In this study, (SPSS 19). A database was created using the software
authors present the incidence and risk factors associated and the frequency of variables was obtained. Univariate
with ROP over an 18-month period from a tertiary care analysis was conducted using a chi-square test to study
hospital in Goa, India. the association between the categorical variables and
outcome.
METHODS
RESULTS
The study was approved by the institutional review board
and was conducted as per the tenets of the declaration of A total of 244 babies fulfilled all the inclusion criteria
Helsinki. Informed consent was obtained from all the and were screened for ROP as detailed above. Thirty-
parents of the neonates enrolled in the study after seven (74 eyes) of the 244 babies (15.16%) developed
explaining the nature of the study. This was a prospective ROP of which 14 babies (28 eyes) (5.73%) developed
observational study conducted for a period of 18 months threshold ROP requiring laser photocoagulation therapy.
in a level II NICU. All neonates weighing ≤1500gm In the remaining 23 babies, the retinopathy regressed
and/or with a gestation ≤ 34 weeks admitted to the NICU spontaneously with complete vascularization (Figure 1).
were included in the study. Infants with lethal congenital
anomalies were excluded.
The initial examination was carried out at 4 weeks after
birth or at 31 to 33 weeks’ postconceptional age,
whichever was later. Following the initial examination,
the retina was examined weekly or every 2 weeks based
on the course and severity of ROP, till complete
vascularization of the retina. Those with ROP were
examined every week till regression occurred or till they
reached the threshold for laser treatment. The screening
was done by an ophthalmologist using a binocular
indirect ophthalmoscope. Babies were swaddled for pain
control. Eyes were examined with an infant speculum and
a Kreissig scleral depressor, under topical anesthesia
using 2% proparacaine drops. The pupils were dilated by
using 5% phenylephrine hydrochloride eye drops diluted
in artificial tear drops in 1:3 dilution,2 drops in each eye
two or three times at an interval of 20 minutes till the
pupils are fully dilated. Retinopathy was graded into Figure 1: Incidence of ROP.
stages and zones as per the international classification of
retinopathy of prematurity (ICROP) classification. Laser Mean gestational age of the study group was 32.05±2.20
photocoagulation was advised for infants who developed weeks and the mean birth weight was 1292.3±240.2 gm.
threshold disease as per ICROP classification. Neonates with threshold ROP had a significantly lower
birth weight (1067.3±185 gm) compared to those with
International Journal of Contemporary Pediatrics | May-June 2019 | Vol 6 | Issue 3 Page 1229Kossambe S et al. Int J Contemp Pediatr. 2019 May;6(3):1228-1234
ROP which spontaneously regressed (1308.9±309 gm) The presence of maternal risk factors like pregnancy
and no ROP (1305.7±228 gm) (p=0.036). induced hypertension/ pre-eclampsia, premature rupture
of membranes for more than 18 hours, symptoms
Similarly, those with threshold ROP requiring laser suggestive of urinary tract infections and
photocoagulation had a significantly lower gestational chorioamnionitis and placental abruption and their
age at birth (29.4±2 weeks) compared to those with ROP association with the occurrence of ROP were analyzed
which spontaneously regressed (31.3±2 weeks) and no using univariate analysis by chi-square test. The P-values
ROP (32.3±2 weeks) (p=0.001) (Table 1). obtained for each were pregnancy induced hypertension/
pre-eclampsia (0.14), premature rupture of membranes
Shows differences in baseline demographics between all for more than 18 hours (0.41), symptoms suggestive of
babies, those with any ROP (which includes all cases of urinary tract infections (0.83), chorioamnionitis (0.98)
ROP) and threshold ROP (which includes those cases of and placental abruption (0.02).
ROP which required laser photocoagulation).
Table 1: Association between ROP and demographic risk factors (univariate analysis).
Characteristics -Demographic Outcome P value
Total babies screened Any ROP
Threshold ROP (n=14)
(n=244) (n=37)
Gender Male 127 (52%) 21 (57%) 7 (50%) 0.671
32 weeks 99 (40%) 9 (24%) 1 (7%)
1500 gm 23 (9%) 6 (16%) 0
SGA ≤SD) 173 (77%) 24 (65%) 9 (64%)
Weight for
AGA 54 (22%) 11 (30%) 4 (29%) 0.804
gestational age
LGA (≥2SD) 17 (1%) 2 (5%) 1 (7%)
*Statistically significant (p28days 1 (7days 22 (9%) 9 (24%) 7 (50%)
International Journal of Contemporary Pediatrics | May-June 2019 | Vol 6 | Issue 3 Page 1230Kossambe S et al. Int J Contemp Pediatr. 2019 May;6(3):1228-1234
Table 3: Comparison of arterial blood gas levels.
ABG levels Outcome P value
Total babies screened Any ROP Threshold ROP
(n=244) (n=37) (n=14)
Not required 108 (44%) 4 (11%) 0
Highest FiO2 0.5 98 (40%) 25 (67%) 12 (86%)
No 107 (44%) 5 (14%) 1 (7%)
Max SO2 (%) >95 136 (56%) 32 (86%) 13 (93%) 0.002*Kossambe S et al. Int J Contemp Pediatr. 2019 May;6(3):1228-1234 oximetry and higher PaO2 values on ABG. These Oxygen therapy, its duration (>7 days) of administration neonates also had significantly higher incidences of and higher FiO2 (FIO2>0.5) had a significant association hyperoxia, and hypercapnia noted on arterial blood gas with ROP in present study. Present study has shown that (Table 3). hyperoxia (PaO2>70mmHg), hypoxia (PaO2
Kossambe S et al. Int J Contemp Pediatr. 2019 May;6(3):1228-1234
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