Retinopathy of Prematurity in the Dominican Republic: Challenges to Screening and Prevention

Abstract

Objective To determine the incidence of retinopathy of prematurity (ROP) in an intensive care nursery in the Dominican Republic and to identify factors that impact ROP outcomes, screening, and treatment.

Study Design A database analysis was performed. The database was prospectively created by the pediatric ophthalmologist in a public maternity hospital in Santo Domingo during 2009. From January to December, all infants (n = 234) who received at least one ophthalmologic examination for ROP were included. ROP screening criteria were based upon: (1) American Academy of Pediatrics guidelines and (2) the presence of critical illness in larger, more mature infants at the discretion of the neonatologist.

Results Overall, 22% were diagnosed with ROP and 4.3% had severe disease. Infants with ROP had a mean birth weight of 1452 g and a mean gestational age of 31 weeks, with 35% having a gestational age >32 weeks. In multivariable regression, only gestational age remained significant (0.8, 0.68 to 0.95). Twenty-two percent diagnosed with ROP did not complete all screening procedures.

Conclusion There are many challenges to preventing and treating ROP in the Dominican Republic. Increased awareness of the detrimental effects of hyperoxia, broader screening criteria, and an improved screening program will help to reduce visual impairment from ROP.

Keywords

retinopathy of prematurity - screening - follow-up - Dominican Republic

• References

• 1 Darlow BA, Hutchinson JL, Henderson-Smart DJ, Donoghue DA, Simpson JM, Evans NJ ; Australian and New Zealand Neonatal Network. Prenatal risk factors for severe retinopathy of prematurity among very preterm infants of the Australian and New Zealand Neonatal Network. Pediatrics 2005; 115: 990-996
• 2 Maida JM, Mathers K, Alley CL. Pediatric ophthalmology in the developing world. Curr Opin Ophthalmol 2008; 19: 403-408
• 3 Section on Ophthalmology American Academy of Pediatrics; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus. Screening examination of premature infants for retinopathy of prematurity. Pediatrics 2006; 117: 572-576
• 4 Gilbert C, Fielder A, Gordillo L , et al; International NO-ROP Group. Characteristics of infants with severe retinopathy of prematurity in countries with low, moderate, and high levels of development: implications for screening programs. Pediatrics 2005; 115: e518-e525
• 5 Fanaroff AA, Stoll BJ, Wright LL , et al; NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol 2007; 196: 147 , e1–e8
• 6 Gilbert C, Rahi J, Eckstein M, O'Sullivan J, Foster A. Retinopathy of prematurity in middle-income countries. Lancet 1997; 350: 12-14
• 7 International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol 2005; 123: 991-999
• 8 Lermann VL, Fortes Filho JB, Procianoy RS. The prevalence of retinopathy of prematurity in very low birth weight newborn infants. J Pediatr (Rio J) 2006; 82: 27-32
• 9 Quinn GE, Gilbert C, Darlow BA, Zin A. Retinopathy of prematurity: an epidemic in the making. Chin Med J (Engl) 2010; 123: 2929-2937
• 10 Gilbert C, Foster A. Childhood blindness in the context of VISION 2020—the right to sight. Bull World Health Organ 2001; 79: 227-232
• 11 Muñoz B, West SK. Blindness and visual impairment in the Americas and the Caribbean. Br J Ophthalmol 2002; 86: 498-504
• 12 Wright KW, Sami D, Thompson L, Ramanathan R, Joseph R, Farzavandi S. A physiologic reduced oxygen protocol decreases the incidence of threshold retinopathy of prematurity. Trans Am Ophthalmol Soc 2006; 104: 78-84
• 13 Tin W, Milligan DW, Pennefather P, Hey E. Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation. Arch Dis Child Fetal Neonatal Ed 2001; 84: F106-F110
• 14 Sears JE, Pietz J, Sonnie C, Dolcini D, Hoppe G. A change in oxygen supplementation can decrease the incidence of retinopathy of prematurity. Ophthalmology 2009; 116: 513-518
• 15 Vento M, Saugstad OD. Oxygen supplementation in the delivery room: updated information. J Pediatr 2011; 158 (2, Suppl) e5-e7
• 16 Lee JW, Davis JM. Future applications of antioxidants in premature infants. Curr Opin Pediatr 2011; 23: 161-166
• 17 Skalet AH, Quinn GE, Ying GS , et al. Telemedicine screening for retinopathy of prematurity in developing countries using digital retinal images: a feasibility project. J AAPOS 2008; 12: 252-258
• 18 Jackson KM, Scott KE, Graff Zivin J , et al. Cost-utility analysis of telemedicine and ophthalmoscopy for retinopathy of prematurity management. Arch Ophthalmol 2008; 126: 493-499
• 19 Salcone EM, Johnston S, VanderVeen D. Review of the use of digital imaging in retinopathy of prematurity screening. Semin Ophthalmol 2010; 25: 214-217