Published online April 1, 2005
PEDIATRICS Vol. 115 No. 5 May 2005, pp. e518-e525 (doi:10.1542/peds.2004-1180)
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ELECTRONIC ARTICLE

Characteristics of Infants With Severe Retinopathy of Prematurity in Countries With Low, Moderate, and High Levels of Development: Implications for Screening Programs

Clare Gilbert, MD*, Alistair Fielder, FRCOphth{ddagger}, Luz Gordillo, MD§, Graham Quinn, MD, MSCE||, Renato Semiglia, MD, Patricia Visintin, MD#, Andrea Zin, MD** on behalf of the International NO-ROP Group

* London School of Hygiene and Tropical Medicine, London, United Kingdom
{ddagger} Imperial College London, London, United Kingdom
§ Hospital Nacional E. Rebagliati, Lima, Peru
|| Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
Hospital Enrique Sotomayor, Guayaquil, Ecuador
# Hospital Oftalmológico Santa Lucía, Buenos Aires, Argentina
** Instituto Fernandes Figueira Fiocruz, Rio de Janeiro, Brazil

Objective. Retinopathy of prematurity (ROP) is a potentially avoidable cause of blindness in children. The proportion of blindness as a result of ROP varies greatly among countries depending on their level of development, being influenced by the availability of neonatal care, neonatal outcomes, and whether effective screening and treatment programs are in place. The objective of this study was to compare characteristics of premature infants who developed severe ROP between 1996 and 2002 in highly developed countries with less developed countries.

Methods. This was an observational study. A questionnaire was completed by ophthalmologists in countries with low, moderate, and high development rankings (3 highly developed countries and from 10 less well-developed countries) who screen for ROP in which they supplied birth weights and gestational ages (GAs) of infants who were treated for threshold ROP or identified with more advanced stages of the disease. Birth weights and GAs of infants with severe ROP were measured.

Results. The mean birth weights of infants from highly developed countries ranged from 737 to 763 g compared with values ranging from 903 to 1527 g in less developed countries. Mean GAs of infants from highly developed countries ranged from 25.3 to 25.6 weeks compared with 26.3 to 33.5 weeks in less developed countries. A total of 13.0% of 1091 infants from poorly developed countries exceeded United Kingdom screening criteria; 3.6% exceeded a criteria of <34 weeks’ GA and/or <1750 g birth weight.

Conclusions. These findings suggest that larger, more mature infants are developing severe ROP in countries with low/moderate levels of development compared with highly developed countries. ROP screening programs need to use criteria that are appropriate for their local population.

Key Words: retinopathy of prematurity • screening • development index

Abbreviations: ROP, retinopathy of prematurity • UNDP, United Nations Development Programme • HDI, Human Development Index • GA, gestational age

Accepted Nov 18, 2004.




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