765 - Prevalence of Retinopathy of Prematurity at a Rural Ugandan Level Two Special Care Nursery

Publication Number: 765.6163

Anna B. Hedstrom, University of Washington School of Medicine, Seattle, WA, United States; Paul Mubiri, Makerere University, Kampala, Kampala, Uganda; Rebecca Jones, Kiwoko Hospital, LUWERO, Nakaseke, Uganda; Molly MacGuffie, n/a, Seattle, WA, United States; Maneesh Batra, University of Washington School of Medicine, Seattle, WA, United States; James Mwangwa. Nyonyintono, Kiwoko hospital, Nakaseke, Nakaseke, Uganda; Iddi Ndyabawe, Kiwoko Hospital, Kampala, Kampala, Uganda

Background: Retinopathy of prematurity (ROP) is a leading cause of blindness in children and occurs almost exclusively in those born preterm who received oxygen therapy. In Uganda, exposure to oxygen therapy and survival among very preterm babies is increasing, potentially markedly increasing prevalence of ROP. Treatment for ROP exists however, detection requires a trained ophthalmologist and standardized screening which have very limited availability in low resource settings.

Objective: A ROP screening program was recently implemented in a rural Ugandan special care nursery and we report the prevalence of ROP at this facility.

Design/Methods: ROP exams were conducted weekly as needed on patients born below 36 weeks gestation by a Ugandan Ophthalmologist between April 2023 and May 2024. The nursery has capacity for bCPAP with blended oxygen and continuous pulse oximetry. Target for the first exam was 2-4 weeks of age and patients were asked to return for exams after discharge as needed. ROP was considered present when stage 1-5 of ROP was identified. Treatment was advised for patients with: stage 2 in zone 2 with pre-plus disease, stage 3 in zone 2 or any stage in zone 1. Laser therapy was not available, and access to intravitreal bevacizumab was available at a referral facility with the cost subsidized. We report descriptive statistics of patient demographics and ROP exam findings from the unit logbook.

Results: 328 patients underwent ROP exams during the period of study, with a median birthweight of 1400 grams [IQR 1140, 1720] and gestational age of 32 weeks [IQR 28-34]. 590 exams were recorded, with a median of 1 exam per patient [IQR 1, 2] and a median postmenstrual age of first exam of 36 weeks [IQR 34, 40].

Prevalence of any ROP was 20% (65/328) and 29% (47/162) for patients < 1500g birthweight.

Among the 71 patients with ROP stage >0, the most severe stage was 3 (11%), 2 (45%) and 1 (44%). Among 84 patients with any zone of ROP, the most severe zone was 1 (8%), 2 (81%) and 3 (10%).
Forty six percent (30/65) of infants with ROP were recommended for treatment. Among these, 90% (27/30) were treated and returned for follow-up exams.

Conclusion(s): We report 20% prevalence of ROP among preterm infants screened in a level two Ugandan special care unit with capacity for blended oxygen. Frequency of treatment was high and reflects conservative practices given limited ability for patient follow-up after discharge and lack of laser therapy. More data is needed including determination of risk factors for ROP in this population in longitudinal studies to determine mitigation approaches and optimal treatment parameters.