A retrospective review of the risk factors associated with retinopathy of prematurity in three academic hospitals in Johannesburg, South Africa

Smith, Suzanne Mari
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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.
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.