A retrospective review of the risk factors associated with retinopathy of prematurity in three academic hospitals in Johannesburg, South Africa
Date
2017
Authors
Smith, Suzanne Mari
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Abstract
Purpose: 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.
Description
A research report submitted to the Faculty of Health Sciences, University
of the Witwatersrand, Johannesburg, in partial fulfilment of the
requirements for the degree of
Master of Medicine in the branch of Ophthalmology
Johannesburg, April 2017.