Published: 2016-12-19

Retinopathy of prematurity: incidence and risk factors: a hospital based study from Shimla, Himachal Pradesh, India

Nitin Kumar, Shayam L. Kaushik, Neelam Grover, Ram L. Sharma


Background: The blindness due to retinopathy of prematurity (ROP) is avoidable, if it is detected in time by screening. With increasing survival of preterm and low birth weight newborns in neonatal units, who are on prolonged oxygen therapy and mechanical ventilation; ROP is bound to affect these babies. This study was planned to investigate the incidence and the risk factors of ROP in a tertiary care institute in Himalayan region of north India.

Methods: This was a hospital based prospective study, conducted at neonatal intensive care units at IGMC, Shimla, from June 2011 to July 2012. 64 premature and low birth weight neonates born or admitted for neonatal intensive care unit (NICU) were screened for ROP using indirect ophthalmoscope. Cases found positive for ROP were closely followed up and managed as per international guidelines.

Results: Out of 64 neonates, 14 were lost to follow up and 50 babies were enrolled in the study. Out of them 21 were males and 29 were females. Among them 3 male and 5 female newborns developed ROP. Mean gestational age of babies with ROP was 30.63 weeks. ROP was significantly associated with oxygen administration (p=0.027), RDS (p=0.003), septicaemia (p=0.028) and exchange transfusion (p=0.003). Apneic spells, surfactant administration, hyperbilirubinemia, phototherapy, blood transfusion and maternal factors were not associated with increased risk of ROP.

Conclusions: For premature infants with birth weight less than 1200 grams, who has received prolonged oxygen therapy, associated respiratory distress and had received exchange transfusion the screening of ROP should be done at most appropriate time that is 32 - 40 weeks of gestational age. Timely referral of detected ROP cases for early treatment prevents blindness. There is a need for the obstetricians, neonatologist and ophthalmologist to work in close co-operation to prevent blindness due to ROP.


Gestational age, Low birth weight, Premature infants, ROP

Full Text:



Terry TL. Extreme prematurity and fibroblastic overgrowth of persistent vascular sheath behind each crystalline lens. Preliminary report. American J Ophthalmol. 1942;25:203-4.

Lucey JF, Dangman B. A re-examination of the role of oxygen in retrolental fibroplasia. Pediatrics. 1984;73:82-96.

Maheshwari R, Kumar H, Paul VK, Singh M, Deorari AK, Tiwari AK. Incidence and risk factors of retinopathy of prematurity in a tertiary care newborn unit in New Delhi. Natl Med J Ind. 1996;9(5):211-4.

Azad RV, Chandra P. Retinopathy of prematurity-screening and management. J Indian Med Asso. 2003;101(10):593-6.

Committee for the classification of retinopathy of prematurity: An international classification of retinopathy of prematurity. Arch Ophthalmol. 1984;102:1130-4.

Rekha S, Battu RR. Retinopathy of prematurity: incidence and risk factors. Indian Pediatr. 1996;33:999-1003.

Hussain N, Clive J, Bhandari V. Current incidence of retinopathy of prematurity. Pediatrics. 1999;105:1-8.

Blair BM, Hallmoran HS, Panly TH, Stevens JL. Decreased incidence of retinopathy of prematurity. J AAPOS. 2001;5(2):118-22.

Patil J, Deodhar J, Wagh S, Pandit AN. High risk factors for development of retinopathy of prematurity. Indian Pediatr. 1997;34:1024-7.

Patz A, Hoeck LE, De La Cruz E. Studies on the effect of high oxygen administration in retrolental fibroplasias. Nursery observations. Am J Ophthalmol. 1952;35:1248-53.

Phelps DL. Retinopathy of prematurity: an estimate of vision loss in the United States. Pediatrics. 1981;67:924-6.

Multicenter Trial of Cryotherapy for Retinopathy of Prematurity (CRYO-ROP). Preliminary results. Cryotherapy for Retinopathy of Prematurity Co-operative Group. Arch Ophthalmol. 1988;106:471-9.

Dutta S, Narang A, Dogra M, Gupta A. Risk factors of threshold retinopathy of prematurity. Indian Pediatr. 2004;41:665-70.

Jalali S, Anand R, Kumar H, Dogra MR, Azad R, Gopal L. Programme planning and screening strategy in Retinopathy of prematurity. Indian J Ophthalmol. 2003;51(1):89-99.