P3.112: Unveiling critical insights: Assessing ROP screening in a Resource Limited Setting

Background: Retinopathy of Prematurity (ROP) is a leading cause of childhood blindness, particularly affecting premature infants with incomplete retinal vascularization. While high-income countries (HICs) primarily report severe ROP in extremely preterm infants ( < 30 weeks, < 1000 g), low- to middle-income countries (LMICs) experience higher rates of severe ROP in more mature infants (>32 weeks, >1500 g). Limited data exist on ROP in Jamaica and the Caribbean. This study evaluates the incidence, severity, risk factors, and completeness of screening for ROP at the Spanish Town Hospital (STH) Jamaica.

Methods: A retrospective descriptive medical record review was conducted at the Level II NICU of Spanish Town Hospital for the period January 1, 2021, to December 31, 2022. Infants meeting the hospital’s ROP screening criteria ( < 32 weeks gestational age, < 1500 g birthweight, prolonged oxygen therapy >7 days, or 32–36 weeks with a stormy clinical course) were included.
Descriptive statistics summarized patient demographics and clinical characteristics. Differences between neonates with and without ROP were analyzed using t-tests for continuous variables and chi-squared tests for categorical variables. Logistic regression identified independent risk factors for ROP development. Statistical analysis was performed using SPSS software, with significance set at p < 0.05. Ethical approval was obtained from the Mona Campus Research Ethics Committee and the South East Regional Health Authority ethics committee.

Results: ROP was diagnosed in 66 infants, with an incidence rate of 45.7% among very low birth weight (VLBW) infants who survived to at least 6 weeks. Most (72.8%) cases had mild ROP, 18 (27.2%) had severe ROP. Five (7.6%) had stage 5. Among larger infants ≥1.5 kg, 26% developed ROP (12 of 46 cases), with 9 cases being mild and 3 cases severe. No cases of stage 5 ROP were identified.
Identified risk factors included lower gestational age, low birthweight, number of blood transfusions, chronic lung disease, and duration of oxygen therapy. Logistic regression confirmed duration of oxygen therapy as the only independent predictor of ROP.
Screening compliance was observed in 87.3% of at-risk infants, but 45.8% of those screened, were screened after 6 weeks of age. No significant difference was observed in ROP occurrence between infants screened at 6 weeks versus those screened later (p = 0.219). Overall there was significant loss to follow-up with only 68.4% returning for follow-up.

Conclusion: The incidence of ROP at Spanish Town Hospital aligns with trends in LMICs, with a high prevalence in VLBW infants and occurrence in bigger, more mature infants (>32 weeks, >1500 g). Duration of oxygen therapy was the strongest predictor of ROP, emphasizing the need for stringent oxygen monitoring. Screening captured most at-risk infants, but significant follow-up loss suggests a need for enhanced tracking and parental education.