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Abstract
Materials and methods Retrospective analysis of 12 years data, of all VLBW screened for ROP, managed by Singapore General Hospital, for maternal, neonatal risk factors using univariate and multiple logistic regressions.
Results Incidence of ROP was 24.8% among all screened VLBW. By univariate analysis, maternal risk factors for severe ROP were prolonged rupture of membrane (PROM), pyrexia, multiple births, tocolysis, fetal disress and vaginal delivery. Neonatal risk factors for ROP were, infant with lower gestational age than 25± 2 weeks (mean + SD), birth weight lesser than 689 ± 147 gm (mean + SD), low Apgar scores, hyaline membrane disease (HMD) requiring surfactant, hypothermia, sepsis, hypotension, patent ductus arteriosus (PDA), air-leak, hypoglycaemia, intraventricular haemorrhage (IVH) increased days on assisted ventilation, CPAP, Oxygen and high mean FiO2 and Chronic lung disease (CLD), are significant risk factors for ROP (p < 0.05).
By multivariate analysis, lower GA (OR = 0.728, 95% CI = 0.609–0.870), lower BW (OR = 0.996, 95% CI = 0.994–0.997) and increased days on oxygen (OR = 1.015,95% CI = 1.006–1.025) were independent risk factor for ROP.
Conclusion High risk factors for severe ROP are extreme preterm infants born vaginally to mother with infection and PROM, multiple birth, used tocolysis, fetal distress with lower GA than 25+2 weeks (mean+SD), with BW lesser than 689+147 gm mean+SD), having low 1,5 min Apgar score, HMD requiring surfactant, hypothermia, sepsis, hypotension, patent ductus arteriosus (PDA), chronic lung disease (CLD), air-leak, hypoglycaemia, intraventricular haemorrhage (IVH). Longer duration of mechanical ventilation, CPAP and oxygen with increased FIO2 due to CLD, are also higher risk of ROP. By multivariate analysis lower GA, BW and increased days on oxygen were found to be high risk factors for ROP. Prevention of extreme prematurity, maternal infection, PROM, optimal ventilator care, with careful titration of oxygen therapy which can decrease CLD may reduce the incidence and severity of ROP in these high-risk ELBW infants.