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

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.

Keywords:

• KIDROP
• preventive care
• rural
• incidence
• laser photoablation
• tele-medicine

Acknowledgments

We acknowledge the contributions of the National Neonatology Foundation, Karnataka state chapter, subcommittee for ROP members, Dr Archana Bilagi, Dr Ranjan Pejaver, Dr Sangappa Dhaded, and Dr Ravindra Battu for their help in framing the guidelines and the KIDROP team members of North Karnataka, Mr Muralidhar Gayakwad, Mr Ravishankar Kandagal and Bangalore team members Mr Praveen Sharma, Mr Sivakumar Munusamy, and Mr Krishnan for their support.

Disclosure

The authors report no conflicts of interest in this work.