Retinopathy of prematurity: a case series of treated infants
| dc.contributor.advisor | Marais, W. J. | |
| dc.contributor.advisor | Rose, A. | |
| dc.contributor.author | Botha, T. C. | |
| dc.date.accessioned | 2019-07-10T07:55:35Z | |
| dc.date.available | 2019-07-10T07:55:35Z | |
| dc.date.issued | 2017-05 | |
| dc.description.abstract | Retinopathy of Prematurity (ROP) is still a major contributor to vision loss in children and account for around 10% of children in schools for the blind in South Africa (SA). Around 14 000 infants are at risk for the development of ROP in SA each year. Oxygen supplementation to the premature infant causes a relative hyperoxia within the retina which results in cessation of normal vascular proliferation. After the supplemental oxygen is stopped, a relative hypoxia causes an abnormal over proliferation of retinal vessels. ROP is the clinical entity which results from this abnormal vascular response. Classification of ROP is clinical and includes three entities: vascular response, zone of retina involved and the presence of plus disease. Retinal detachments can result, and this comprises stage 4 and 5 of the classification. Treatment is according to the ETROP study. The classification above is used to further classify the disease into Type 1 and 2, and then treated accordingly. Many risk factors have been identified in contributing to the development of ROP. Some major risk factors include: gestational age, birth weight, poor postnatal weight gain and supplemental oxygen administration. Protective factors include human breastmilk and fresh frozen plasma. Three ROP epidemics have been identified. The first epidemic was with the advent of supplemental oxygen in the 1950’s. Infants with ROP in the United Kingdom at the time had birth weights of 1370g. In the 1970’s neonatal care improved, and we saw the second epidemic as the birth weights of infants with ROP dropped to below 1000g. Now, at the turn of the century, we are seeing a 3rd epidemic in middle-income countries with infants having ROP with birth weights of 900g to 1500g. For comparison, infants with ROP in developed countries have birth weights of around 750g and below. Screening for ROP is necessary but sometimes difficult in resource constraint environments. Therefore, algorithms have been developed to try and decrease the number of infants that need screening. A major successful algorithm is the WINROP algorithm. This algorithm is web based, and needs only the gestational age, birth weight and postnatal weight gain to determine whether an infant is at risk for the development of ROP. It has proven 100% sensitive in some developed countries. The aim of this study was to determine the risk factors present in infants with ROP in our province. Secondary objectives included: the comparison of the WINROP detection rate in our infants with those in developed countries; to identify major issues in neonatal care in the province; and to document the ROP stage prior to treatment and treatments given. This was a case series. Records were reviewed of all infants treated for ROP at a single referral unit, Universitas Academic Hospital, during the time period of 2009 to 2015. Ethics approval was obtained for this study. Most infants were of African race. All infants were from the two major referral centres within the Free State. The averages for gestational age and birth weight were 27.6 weeks (range 26 to 30 weeks) and 1061.2 grams (range 760 to 1405 grams) respectively. The day original birth weight was reached on average was on day 22 (range 9 to 56 days). Other parameters which showed a high presence factor were: oxygen supplementation, proven sepsis and breastmilk administration. The WINROP algorithm showed an alarm in 75% (n9) of cases. This means that 25% (n3) were not detected by 6 weeks of age when screening would already have been implemented. One unit showed a target oxygen saturation of >95% in all treated infants. In conclusion, the study confirms that SA forms part of the third epidemic of ROP. The WINROP algorithm is not accurate in our population with larger infants. A site with poor post-natal oxygen saturation monitoring was identified. It is recommended that further study is needed before the implementation of the WINROP algorithm in SA. Education of staff involved with neonatal care concerning oxygen saturation targets is important. | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11660/10018 | |
| dc.language.iso | en | en_ZA |
| dc.publisher | University of the Free State | en_ZA |
| dc.rights.holder | University of the Free State | en_ZA |
| dc.subject | Dissertation (M.Med. (Ophthalmology))--University of the Free State, 2017 | en_ZA |
| dc.subject | Retinopathy of Prematurity (ROP) | en_ZA |
| dc.subject | Vision loss | en_ZA |
| dc.subject | Children | en_ZA |
| dc.subject | Risk factors | en_ZA |
| dc.subject | Treatment | en_ZA |
| dc.subject | Screening | en_ZA |
| dc.subject | Detection rates | en_ZA |
| dc.title | Retinopathy of prematurity: a case series of treated infants | en_ZA |
| dc.type | Dissertation | en_ZA |