3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item A retrospective review of the risk factors associated with retinopathy of prematurity in three academic hospitals in Johannesburg, South Africa(2017) Smith, Suzanne MariPurpose: Retinopathy of prematurity (ROP) is a leading cause of preventable blindness worldwide. Numerous studies have attempted to identify the many risk factors for this condition. While risk factors have been identified in previous studies, there remains a lack of information specific to the South African population. The purpose of this study was to try and identify possible risk factors in an African population that may differ from studies done in other areas of the world. Secondarily by identifying important risk factors in South African population, screening could be further tailored to try and decrease the load on a very strained health system as well as aiming education for smaller hospitals to try and manage babies correctly to decrease the prevalence of this devastating disease. Methods: Medical information from an eight-year period for infants with proven ROP that required treatment and for their mothers was reviewed from three public sector hospitals in Gauteng. A matched control group of babies who did not present with ROP were compared to the ROP group. Results: There were 64 babies in the treatment group and 63 babies in the control group (no ROP). Results showed that babies with ROP were significantly smaller (mean birthweight of 1064g compared to 1210g), had a shorter gestational age (average of 28.3 weeks compared to 29.9 weeks) and were significantly more likely to receive a blood transfusion. Weaker evidence showed that the babies with ROP all received oxygen therapy, were more likely to undergo mechanical ventilation, receive nitric oxide and have neonatal sepsis. The treatment group also showed a trend towards having a higher likelihood of hypotension and hyperglycaemia (requiring insulin). The ethnicity of the babies did not differ between groups with most of the babies being African (96% and 94% respectively, ROP and control groups). The prevalence of HIV between and within groups could not be reliably established due to lack of available data. Conclusion: Well documented risk factors as well as some lesser established risk factors were shown to predict ROP in this population group. The lack of note keeping of important risk factors by attendant medical staff proved problematic and requires attention. The current ROP-screening guidelines in use in South Africa (screening babies of under 1500g) are acceptable and should not be reduced if economically possible, to the guidelines used in some first world countries (screening of babies under 1250g) as this would increase the chances of missing the diagnoses of ROP (7 out of 63 treated babies in this study’s treatment group would have been missed) in premature infants.Item An evaluation of retinopathy in very low birth weight babies at Charlotte Maxeke Johannesburg academic hospital(2016) Dadoo, ZahedahBackground. Retinopathy of prematurity (ROP) is a leading cause of blindness for very low birth weight (VLBW, <1500g) babies. ROP screening identifies babies that require treatment to prevent major visual impairment. Objectives. To evaluate the screening for ROP at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) by reviewing the number of babies screened according to the CMJAH guidelines, the grades of ROP found and the treatment modality received. Methods. This was a retrospective record review of VLBW babies born between 1 January 2013 and 31 December 2013 at CMJAH, whether inborn or transferred in. The babies were divided into 2 groups based on age at final outcome. Final outcome was defined as death, discharge or transfer out of the unit. The ‘early’ outcome group had their final outcome before day 28 of life. The ‘late’ outcome group had their final outcome at day 28 or more of life. The early outcome group qualified for outpatient ROP screening and the late outcome group qualified for inpatient ROP screening. Results. There were a total of 572 VLBW babies at CMJAH during this time period. The babies had a mean birth weight of 1127g (SD 244.75) and gestational age of 29 weeks (SD 2.743). The mean duration of stay was 29 days (SD 21.66) and there were 309 female babies. Of these 572 babies, 304 comprised the early outcome group and 268 comprised the late outcome group. 7 In the early outcome group babies that were transferred out of the unit or died were excluded, therefore the remaining 147 babies discharged home qualified for outpatient ROP screening. Inpatient ROP Screening was carried out in 36/147 (24.4%) of these babies (not in accordance with ROP screening guidelines). ROP was documented in 4/36 (11.1%). Outpatient ROP screening records were unavailable. Exclusions from the late outcome group included 5 babies. In the late outcome group 111/263 (42.2%) were screened for ROP. ROP was found in 17%. One baby required treatment with intravitreal anti-VEGF and 3 babies required surgery. Conclusions. More than half of the babies in the late outcome group were not screened during their stay (57.8%). More than one third of babies were discharged prior to reaching the current recommended age for screening. Efforts need to be intensified to identify and screen all eligible babies prior to discharge. Outpatient ROP screening is not well documented, therefore prevalence cannot be established.