Abstract
Objectives
To investigate risk factors for retinopathy of prematurity (ROP) in a newly established ROP screening and management programme in Rwanda, Africa.
Methods
In this multi-centre prospective study 795/2222 (36%) babies fulfilled the inclusion criteria (gestational age (GA) < 35 weeks or birth weight (BW) < 1800 g or unstable clinical course), 424 (53%) of whom were screened for ROP. 270 died before the first screening. ROP and treatment-warranted ROP were classified using the revised International Classification of ROP (2005). Data on maternal and perinatal risk factors were collected from daily neonatal notes.
Results
31 babies (7.3%, CI 5.0–10.2) developed any ROP, 13 of whom (41.9%, CI 24.5–60.9) required treatment. ROP was seen in six neonates with GA > 30 weeks and BW > 1500 g, one of whom required treatment. In univariate analysis the following were associated with any ROP: increasing number of days on supplemental oxygen (OR 2.1, CI 1.5–3.0, P < 0.001), low GA (OR 3.4, CI 1.8–6.4, P < 0.001), low BW (OR 2.3, CI 1.5–3.4, P < 0.001), at least one episode of hyperglycaemia ≥ 150 mg/dl (OR 6.6, CI 2.0–21.5, P < 0.001), blood transfusion (OR 3.5, CI 1.6–7.4, P < 0.001) or sepsis (OR 3.2, CI 1.2–8.6, P = 0.01). In multivariate analysis longer exposure to supplemental oxygen (OR 2.1, CI 1.2–3.6, P = 0.01) and hyperglycaemia (OR 3.5, CI 1.0–12.4, P = 0.05) remained significant.
Conclusions
ROP has become an emerging health problem in Rwanda, requiring programmes for screening and treatment. ROP screening is indicated beyond the 2013 American Academy guidelines. Improved quality of neonatal care, particularly oxygen delivery and monitoring is needed.
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Change history
04 September 2019
A Correction to this paper has been published: https://doi.org/10.1038/s41433-019-0561-5
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Acknowledgements
The authors would like to acknowledge the members of the Rwanda Retinopathy of Prematurity (ROP) Study Group for their valuable contribution to this study (alphabetical order): Cannoodt Luk, PhD, Health Policy Analyst, KU Leuven (Belgium), NGO Umubano-Impore; Casteels Ingele, MD, PhD, Paediatric Ophthalmologist, KU Leuven, Belgium; Conard Craig, MD, MPH, Paediatrician CHUB; De Smedt Stefan, MD, PhD, ophthalmologist/epidemiologist, AZ St Maarten, Mechelen, Belgium; Devlieger Hugo, MD, PhD, neonatologist, KU Leuven, Belgium; Fonteyne Yannick, MD; Gilbert Clare, MD, PhD, International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK; Gisagara Egide, MD, ophthalmologist ; Kumwami Muzungu, MD, paediatrician CHUK; Mudereva Godelieve, MD, ophthalmologist CHUK; Muhizi Charles, MD, ophthalmologist CHUB; Mulindwa Karemazi Gustave, MD, paediatrician CHUB; Musiime Stephenson, MD, FCPaeds(SA), paediatrician KFH; Mutangana Francis, MD, ophthalmologist KFH; Mutsinzi Edison, MD, ophthalmologist Kabgayi Eye Unit; Ngambe Tharcisse, MD, paediatrician KFH; Noë Piet, MD, ophthalmologist Kabgayi Eye Unit, Rwanda Charity Eye Hospital; Nsabimana Hovaire, MD, paediatrician CHUB; Nyemazi Alex, MD, ophthalmologist KFH; Sebuseruka Sonia, MD, ophthalmologist; Tuyisabe Theophile, MD, ophthalmologist Kabgayi Eye Unit; Tuyisenge Lisine, MD, paediatrician CHUK; Uwurukundo Marie Claude, MD, paediatrician KFH; Van Kerschaver Erwin, MD PhD.
Funding
Hoffknecht Van Vuure Stichting (The Netherlands), Vision for All (Switzerland), Rotary Club Overijse Zonienwoud (Belgium), Lions Club Heerlijkheid Mechelen (Belgium), Lumos University Hospitals Leuven (Belgium), Théa Pharma, NGO Umubano- Impore (Rwanda). The funding organizations had no role in the design or conduct of this research.
Rwanda Retinopathy of Prematurity (ROP) Study Group
Luk Cannoodt11, Ingele Casteels9, Craig Conard7, Stefan De Smedt10, Hugo Devlieger12, Yannick Fonteyne8, Clare Gilbert13, Egide Gisagara3, Muzungu Kumwami6, Godelieve Mudereva3, Charles Muhizi2, Gustave Mulindwa Karemazi7, Stephenson Musiime5, Francis Mutangana1, Edison Mutsinzi14, Tharcisse Ngambe5, Piet Noë15, Hovaire Nsabimana7, Alex Nyemazi1, Sonia Sebuseruka16, Theophile Tuyisabe14, Lisine Tuyisenge6, Marie Claude Uwurukundo5, Erwin Van Kerschaver
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Meeting presentation: The work has been accepted and presented as Poster Presentation (Poster 186-B0340, abstract #2906642) for the 2018 ARVO Annual Meeting in Honolulu.
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Mutangana, F., Muhizi, C., Mudereva, G. et al. Retinopathy of prematurity in Rwanda: a prospective multi-centre study following introduction of screening and treatment services. Eye 34, 847–856 (2020). https://doi.org/10.1038/s41433-019-0529-5
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DOI: https://doi.org/10.1038/s41433-019-0529-5
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