Boopathy, V (2013) Clinical Profile Risk Factors and Outcome of Newborn Babies with Retinopathy of Prematurity in a Tertiary Care Centre. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: Retinopathy of Prematurity is a neovascularising disease of premature retina that in it’s most severe form can lead to retinal detachment and subsequent blindness. ROP is a multifactorial vasoproliferative disorder of retina, that increases in incidence with decreasing gestational age and birth weight. Approximately 65% of infants with a birth weight of <1250 gm, and 80% of infants with a birth weight <1000 gm, will develop some degree of ROP. In view of ongoing trend for resuscitation of smaller infants with lower gestational ages along with increased survival of VLBW & ELBW babies, an increase in incidence of ROP is expected. PATHOGENESIS OF ROP: Beginning at 16 weeks, retinal angiogenesis normally proceeds from the optic disc to periphery reaching the outer rim of the retina nasally at about 36 weeks and extending temporally by approximately 40 weeks20. Injury to this process may result in pathological changes in the growing retina. Initially it causes cessation of vasculogenesis followed by abrupt termination of vessels marked by a thin line in the retina which then grows into an ridge made up of mesenchymal and endothelial cells. Cell division and differentiation may resume later and vascularisation of retina may proceed. Sometimes, abnormal proliferation of vessels out of the plane of the retina, into the vitreous and over the surface of the retina may occur. Then it is followed by cicatrization and traction on the retina may occur and which can lead to retinal detachment. AIM OF THE STUDY: 1. To find out the incidence, risk factors and outcome of newborn babies with Retinopathy of Prematurity in a tertiary care centre. 2. To find out the effectiveness of laser photocoagulation among the Newborn babies with Retinopathy of Prematurity. OBJECTIVES OF THE STUDY: 1. To study the clinical profile of ROP in new born babies with ROP in an extramural centre. 2. To find out the outcome of ROP following laser therapy. 3. To follow up the newborn babies with ROP after screening for the final outcome. SUMMARY: ROP is a preventable cause of blindness and vision related morbidity. As there are improvement in neonatal health care facilities and Neonatal Intensive Care Units, the survival of more and more VLBW & ELBW babies are increasing who are at risk for developing ROP. So the incidence of ROP is in increasing trend all over the world. More over no good epidemiological data on ROP in Tamil Nadu is available. Hence we conducted a prospective study to determine the incidence, risk factors, clinical outcome of laser therapy among the newborn babies with birth weight <1500gm, and /or gestational <34 weeks admitted in our newborn wards. Total of 202 newborns were included in this study, among them 73 developed ROP. The overall incidence of ROP was found to be 36.1%. We also found that lesser gestational age, lower birth weight, RDS, apnea, NNH, oxygen therapy, use of blood products were found to be significant risk factors. Efficacy of laser photo coagulation was 94.7%. 36 out of 38 infants treated with laser showed regression ROP. CONCLUSION: In our study, we conclude that the incidence of ROP was 36.1% . The risk factors for the development of ROP were also similar to those mentioned in earlier studies like prematurity, oxygenation, sepsis, respiratory distress. Proper screening of at risk babies found to be cost effective in preventing from the development of ROP. We recommed that intial assessment for screening of ROP to be done as early as at least 4 weeks post natal age or 34-35 weeks postconceptional age and these babies are to be followed till term gestation. Laser photocoagulation found to be a safer therapeutic procedure with good outcome and milder complications. Larger birth weight babies and gestationally more older babies may also develop ROP. So, the criteria for ROP screening should be extended to the larger birth weight babies upto 1.8 kg and older gestational age babies upto 36 weeks especially those with risk factors like sepsis, apnea, RDS and those who need blood transfusion. It seems that prevention of premature and deliveries and judicious use of oxygen are found to be the main step for prophylaxis of ROP.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Clinical Profile Risk Factors ; Newborn Babies ; Retinopathy ; Prematurity ; Tertiary Care Centre |
| Subjects: | MEDICAL > Paediatrics |
| Depositing User: | Ravindran C |
| Date Deposited: | 06 Apr 2018 07:01 |
| Last Modified: | 08 Apr 2018 11:11 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6889 |
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