Retinopathy of Prematurity in a Rural Neonatal Intensive Care Unit in South India—A Prospective Study

Objective To report the incidence, spectrum and treatment outcome of Retinopathy of Prematurity (ROP) in a rural neonatal nursery. Methods This Prospective, observational, non-randomized study was conducted in a level III Neonatal Intensive Care Unit (NICU) at district headquarters in South India. 118 babies with birth weight ≤2000 g and/or period of gestation (POG) ≤34 wk were included in the study. Eligible infants were screened with indirect ophthalmoscopy and wide-field digital imaging (Retcam) until retinal vascularization was complete or disease regressed. Early Treatment Retinopathy of Prematurity (ETROP) guidelines were followed for laser. Results The overall incidence of ROP was 41.5% and treatable ROP was 26.4% (24/91) of eyes diagnosed with ROP and 10.2% (24/236) of the overall eyes screened. The mean birth weights and periods of gestation with and without ROP were 1555.9 vs. 1672.5 g ( P 0.005) and 32.2 vs. 34.6 wk, respectively ( P < 0.001). Half of the treated eyes had aggressive posterior ROP in Zone 1. All treated eyes had a favorable outcome. Respiratory distress syndrome, oxygen therapy, neonatal Jaundice and sepsis were higher in the ROP group but was not statistically significant. Of the overall infants screened, 68 (57.6%) were heavier and older than the American screening cut-off. Of these, 36.8% had some stage ROP and 8% required treatment. Conclusions This is the first prospective ROP study from a district NICU in India and compares with previously published urban data. If Western-screening guidelines are used in the rural scenario, we risk a significant proportion of infants being missed who may require treatment.