Retinopathy of Prematurity in Very Low Birthweight Neonates of Gestation Less Than 32 weeks in Malaysia

Nem Yun Boo; Ee Lee Ang; Eric Boon-Kuang Ang

doi:10.1007/s12098-023-04997-9

Retinopathy of Prematurity in Very Low Birthweight Neonates of Gestation Less Than 32 weeks in Malaysia

Indian J Pediatr. 2024 Jan 11. doi: 10.1007/s12098-023-04997-9. Online ahead of print.

Authors

Nem Yun Boo¹, Ee Lee Ang², Eric Boon-Kuang Ang³

Affiliations

¹ Department of Population Medicine, Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Jalan Sungai Long, Bandar Sungai Long, Kajang, 43000 Selangor, Malaysia. boony@utar.edu.my.
² Department of Pediatrics, Tengku Ampuan Rahimah Hospital, Ministry of Health of Malaysia, Klang, Selangor, Malaysia.
³ Department of Pediatrics, Sultanah Bahiyah Hospital, Ministry of Health, Alor Setar, Kedah, Malaysia.

PMID: 38200381
DOI: 10.1007/s12098-023-04997-9

Abstract

Objectives: To determine the screening rates and incidence of retinopathy of prematurity (ROP), and risk factors associated with ROP in very low birthweight (VLBW, <1500 g) neonates of gestation <32 wk admitted to neonatal intensive care units (NICUs) in a middle-income country.

Methods: It was a retrospective cohort study of prospectively submitted data by 44 Malaysian NICUs participating in the Malaysian National Neonatal Registry. All VLBW neonates of gestation <32 wk born in 2015-2020 and survived to discharge were included.

Results: Of 11768 survivors, 90.5% (n = 10436) had ROP screening; 16.1% (1685/10436) had ROP. ROP was significantly more common in neonates <28 wk gestation (extremely preterm, EPT) than ≥28 wk gestation (37.7% vs. 9.7%; p <0.001), and more common in those with birthweight <1000 g (extremely low birthweight, ELBW) than ≥1000 g (32.9% vs. 9.1%; p <0.001). Multiple logistic regression analysis showed that the significant independent factors associated with increased risk of ROP were ELBW, EPT, Indian ethnic group, vaginal delivery, mechanical ventilation >5 d, high frequency ventilation, total parenteral nutrition, late-onset sepsis, bronchopulmonary dysplasia, and intraventricular hemorrhage. Receiving oxygen therapy at birth was associated with significantly lower risk of ROP.

Conclusions: The incidence and severity of ROP increased with decreasing gestation and birthweight. Prolonged duration of oxygen therapy, infection, invasive respiratory support, and conditions commonly causing fluctuations of oxygenation were significant factors associated with increased risk of ROP. Receiving oxygen at birth did not increase risk.

Keywords: Extremely preterm; Malaysia; Retinopathy of prematurity; Risk factors; Very low birthweight; Very preterm.