Prevalence and pattern of retinopathy of prematurity at two national referral hospitals in Uganda: a cross-sectional study

Abstract

Background Retinopathy of prematurity (ROP) is a leading cause of blindness in children and an ROP epidemic is predicted this decade in sub-Saharan Africa. With the increasing survival rate of preterm babies in Uganda, and no data on ROP prevalence, there is a need to assess the burden of ROP to inform preventive strategies and targeted screening. Methods We conducted a two-center cross-sectional study of preterm (< 37 weeks gestational age) infants from the neonatal units of Kawempe National Referral Hospital (KNRH) and Mulago Specialised Women and Neonatal Hospital (MSWNH) from August 2022 to October 2022. An ophthalmologist examined all participants using an indirect ophthalmoscope with a + 20D convex lens and captured digital images using a Volk iNview™ Fundus Camera. The collected data were entered into Epidata 4.2 and exported to Stata 14.0 for analysis. Results 331 preterm infants enrolled in this study. The oxygen received was unblended. The mean gestational age was 30.4 ± 2.7 weeks, and the mean birth weight was 1597 ± 509 g. 18/101 (17.8%) were found to have any ROP amongst the preterm infants recruited from MSWNH, 1/230 (0.4%) from KNRH [95% CI] had any stage of ROP (i.e. stage 5). Of these, 8 (42.1%) had stage 2 ROP. Infants with a birth weight below 1500 g were 10 times more likely to have ROP than those among infants with a birth weight more than 1500 g [AOR: 10.07 (2.71–37.44)]. Infants who were not fed exclusively on breast milk had higher odds of having ROP than those exclusively fed on breast milk [AOR: 7.82(1.92–31.82)]. Conclusion 6% of preterm infants born in two tertiary hospitals in Uganda were found to have ROP. Lack of exclusive feeding on breast milk and birth weight of less than 1500 g were strong predictors of ROP. The higher prevalence of ROP in MSWNH calls for cautious use of oxygen among preterms. We recommend targeted ROP screening for those at risk.

Blindness Due to Retinopathy of Prematurity: A Literature Review

“…The higher prevalence of ROP and severe ROP in the study conducted by Bastola (2023) can largely be attributed to supplemental oxygen therapy (Agrawal et al, 2023). Oxygen therapy contributes to ROP by affecting retinal vascularisation through the regulation of vascular endothelial growth factor (Ndyabawe et al, 2023). Conservative use of supplemental oxygen is a risk factor for developing ROP in premature infants in Palestine (P < 0.0010) either by non-mechanical "C-pap or nasal cannula" (P < 0.0010) or mechanical ventilation methods (P = 0.0070) (Akkawi et al, 2019).…”

“…So that in premature babies born before 28 weeks, the development of the retina is not perfect and is at risk of ROP (Yahya, 2020). Retinopathy of prematurity is also common in infants with a birth weight of <1500 grams (Ndyabawe et al, 2023). This may be because the gestational age at birth is too small so that the birth weight is too small and lower than normal babies, so that various body functions are not fully developed, especially the development of immature retina, and in premature babies themselves can cause retinal damage (Y.…”

“…(Zhang et al, 2022) . Infants who are not exclusively breastfed play a role in the development of ROP because the protective role of breast milk by long-chain polyunsaturated fatty acids in counteracting oxygen free radicals is very important in protecting infants from ROP (Ndyabawe et al, 2023). Other risk factors for ROP are anaemia and blood transfusion (Zarei et al, 2019) (AlBalawi et al, 2020) (Shalaby et al, 2021.…”