Examination of preterm babies for ROP referred to an eye department from an urban and semi-urban neonatal intensive care unit: implications for practice

Background: To study and analyse the factors affecting the proportion of retinopathy of prematurity (ROP) distribution between the urban and semi-urban regions in North India. Methods: Retrospective, observational, cross-sectional study. All babies referred for ROP examination by paediatricians or other general ophthalmologists between 2013 – 2016 were included in the study. Demographic, clinical and treatment related findings were recorded. Results: Five hundred and fifty-eight (467: urban & 91: semi urban) babies were examined for ROP. The mean birth weight in the urban and semi-urban setting was 1348.6 ± 395.21 gm and 1703.77 ± 401.76 gm respectively. The mean gestational age was 30.99 ± 2.93 weeks and 30.73 ± 2.08 weeks in the urban and semi-urban cohorts respectively. The average time for first ophthalmic examination following birth was 23.82 ± 13.69 (range: 3-77) days in the urban and 101.16 ± 238.26 (range: 13- 330) days in the semi-urban setting. 94% of the babies completed all screening examination visits. Any ROP was identified in 11.6% and 33.0% of the urban and semi-urban cohorts respectively; Type 1 was detected in 7.5% of urban babies and 23.1% of semi-urban babies Conclusion: Differences in the proportion of babies developing any ROP and Type 1 ROP between the semi-urban and urban groups is likely due to selection bias, as a high proportion of semi-urban babies did not attend for examination or failed to complete all the examinations necessary. This was particularly true for females. More needs to be done to increase access to regular, systematic screening of preterm babies within neonatal units.