Impact of improved neonatal care on the profile of retinopathy of prematurity in rural neonatal centers in India over a 4-year period.

IF 3.1 Q1 OPHTHALMOLOGY Eye and Brain Pub Date : 2016-05-20 eCollection Date: 2016-01-01 DOI:10.2147/EB.S98715

Anand Vinekar, Chaitra Jayadev, Siddesh Kumar, Shwetha Mangalesh, Mangat Ram Dogra, Noel J Bauer, Bhujang Shetty

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引用次数: 21

Abstract

Purpose: To report the reduction in the incidence and severity of retinopathy of prematurity (ROP) in rural India over a 4-year period following the introduction of improved neonatal care practices.

Methods: The Karnataka Internet Diagnosis of Retinopathy of Prematurity program (KIDROP), is a tele-medicine network that screens for ROP in different zones of Karnataka state in rural India. North Karnataka is the most underdeveloped and remote zone of this program and did not have any ROP screening programs before the intervention of the KIDROP in 2011. Six government and eleven private neonatal centers in this zone were screened weekly. Specific neonatal guidelines for ROP were developed and introduced in these centers. They included awareness about risk factors, oxygen regulation protocols, use of pulse oxymetry, monitoring postnatal weight gain, nutritional best practices, and management of sepsis. The incidence and severity of ROP were compared before the guidelines were introduced (Jan 2011 to Dec 2012) and after the guidelines were introduced (July 2013 to June 2015).

Results: During this 4-year period, 4,167 infants were screened over 11,390 imaging sessions. The number of enrolled infants increased from 1,825 to 2,342 between the two periods (P<0.001). The overall incidence of any stage ROP reduced significantly from 26.8% to 22.4% (P<0.001). The incidence of treatment-requiring ROP reduced from 20.7% to 16% (P=0.06), and of the treated disease, aggressive posterior ROP reduced from 20.8% to 13.1% (P=0.23) following introduction of the guidelines.

Discussion: Rural neonatal centers in middle-income countries have a large, unscreened burden of ROP. Improving neonatal care in these centers can positively impact the incidence and severity of ROP even in a relatively short period. A combined approach of a robust ROP screening program and improved neonatal care practices is required to address the challenge.

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改善新生儿护理对印度农村新生儿中心4年早产儿视网膜病变概况的影响。

目的:报告印度农村早产儿视网膜病变(ROP)的发病率和严重程度在引进改进的新生儿护理实践后的4年期间的降低。方法:卡纳塔克邦互联网早产儿视网膜病变诊断项目(KIDROP)是一个远程医疗网络，在印度农村卡纳塔克邦的不同地区筛查视网膜病变。北卡纳塔克邦是该项目最不发达和偏远的地区，在2011年KIDROP干预之前没有任何ROP筛查项目。该地区的6个政府和11个私人新生儿中心每周进行筛查。这些中心制定并介绍了新生儿ROP的具体指南。其中包括对危险因素的认识、氧气调节方案、脉搏血氧仪的使用、产后体重增加的监测、营养最佳做法和败血症的管理。比较指南实施前(2011年1月至2012年12月)和实施后(2013年7月至2015年6月)ROP的发生率和严重程度。结果:在这4年期间，4167名婴儿接受了11,390次影像学检查。在这两个时期，入组婴儿的数量从1825名增加到2342名(PPP=0.06)，在接受治疗的疾病中，引入指南后，侵袭性后路ROP从20.8%减少到13.1% (P=0.23)。讨论:中等收入国家的农村新生儿中心存在大量未经筛查的ROP负担。在这些中心改善新生儿护理可以积极影响ROP的发生率和严重程度，即使在相对较短的时间内。需要一个强有力的ROP筛查项目和改进的新生儿护理实践相结合的方法来应对这一挑战。

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来源期刊

Eye and Brain OPHTHALMOLOGY-

CiteScore

7.90

自引率

2.30%

发文量

审稿时长

16 weeks

期刊介绍： Eye and Brain is an international, peer-reviewed, open access journal focusing on basic research, clinical findings, and expert reviews in the field of visual science and neuro-ophthalmology. The journal’s unique focus is the link between two well-known visual centres, the eye and the brain, with an emphasis on the importance of such connections. All aspects of clinical and especially basic research on the visual system are addressed within the journal as well as significant future directions in vision research and therapeutic measures. This unique journal focuses on neurological aspects of vision – both physiological and pathological. The scope of the journal spans from the cornea to the associational visual cortex and all the visual centers in between. Topics range from basic biological mechanisms to therapeutic treatment, from simple organisms to humans, and utilizing techniques from molecular biology to behavior. The journal especially welcomes primary research articles or review papers that make the connection between the eye and the brain. Specific areas covered in the journal include: Physiology and pathophysiology of visual centers, Eye movement disorders and strabismus, Cellular, biochemical, and molecular features of the visual system, Structural and functional organization of the eye and of the visual cortex, Metabolic demands of the visual system, Diseases and disorders with neuro-ophthalmic manifestations, Clinical and experimental neuro-ophthalmology and visual system pathologies, Epidemiological studies.