Factors associated with development of retinopathy of prematurity in three private tertiary hospitals in Kenya

Introduction: Retinopathy of prematurity (ROP) is a condition that affects mainly premature infants. It’s characterized by abnormal retinal vascular growth which in its most severe form can result in blindness due to retinal detachment, and in less severe untreated forms, can result in marked visual impairment. Retinopathy of prematurity is one of the preventable causes of blindness. Research Question: What are the factors associated with development of retinopathy of prematurity in screened preterm infants in three private tertiary hospitals in Kenya? Study Objectives: This study aimed to identify factors associated with development of retinopathy of prematurity in screened preterm infants in three private tertiary hospitals in Kenya. It also aimed to determine the proportion of preterm infants with retinopathy of prematurity in the screened preterm infants within these three hospitals. Study Methods: This was an unmatched case control study, targeting records of preterm infants born between January 2010 to December 2017, in three private tertiary hospitals in Kenya. Data extracted was on gestational age at birth, birth weight, gender, duration of supplemental oxygen, occurrence of sepsis, intra ventricular hemorrhage and blood transfusion. The outcome assessed was a binary variable, defined as retinopathy of prematurity status, Positive or Negative. Results: A total of 228 patient records were included in the study. Overall proportion of ROP positive cases was 43.3% (95% CI: 36.9%-50.1%). Approximately half, (50.8%) of the babies who were put on oxygen supplementation for more than one week were ROP positive, however the proportions were similar for babies with and those without sepsis at 58.0% and 55.0% respectively. The proportion of preterm infants with ROP was lower in babies who were transfused compared to those who were not transfused (48.6% vs 63.6%). Gestational age (p-value=0.002), duration of oxygen therapy (p-value=0.012), and blood transfusion (p-value=0.022) were independently associated with ROP infection. Conclusion and Recommendations: The proportion of preterm infants who screened ROP positive in this study was 43.4% which was used as a proxy for prevalence of this condition in screened preterm infants in these three facilities. This serves as an indicator of the burden of this condition on preterm infants. Associated factors from this study were gestational age at birth, duration of supplemental oxygen and blood transfusion. Early weaning off from supplemental oxygen and judicious transfusions could possibly make an impact in reducing the prevalence of this condition. We recommend that there should be a national policy on screening of preterm infants targeting at risk preterm infants. There are alternative ways of screening for retinopathy of prematurity such as digital imaging where medical personnel who are not ophthalmologists can take retinal images of preterm infants at risk of developing ROP and send these images to ophthalmologists who can then advice on the treatment options