Screening and follow up of ROP

In this webinar we will learn about screening and follow up for Retinopathy of prematurity
We shall learn: whom to screen for retinopathy of prematurity, when to screen, who will screen, how to prepare a baby for screening and how to plan follow up
Birth weight less than 2000 grams OR Gestation age less than 35 weeks Any preterm infant with risk factors: Cardio-respiratory instability Prolonged oxygen therapy Repeated episodes of apnea of prematurity, History of blood transfusion Sepsis Poor postnatal weight gain
Now, coming to the time when this screening has to be done First screening should be done no later than 4 weeks of age But for infants between 24-30 week gestational age or Birth weight < 1200 gram: It should be done earlier that is 2-3 weeks after delivery (Keep in mind that it should not be later than 3 weeks)
Retinopathy of prematurity screening should be done by a trained eye specialist using indirect ophthalmoscopein NICU/SCNU,if the baby is still admitted. If baby is discharged, then screening can be done in a defined area in SCNU on an outpatient basis
For preparation of babies prior to screening, they should be kept NPO for 2 hours. For dilating pupils 1 drop of 0.5-1% Tropicamide should be instilled in both the eyes every 15 mins for 3-4 times. After that 1 drop of 2.5% Phenylephrine should be instilled once, 10 minutes before the screening procedure. Next step is to instill Topical anesthetic drops: Paracaine. For pain control during the procedure, 2mL of 25% sucrose should be given orally, 2 minutes before the procedure. Antibiotic eye drops should be instilled for 3 days post procedure. For preparation and dilution of eye drops, please refer to the figure shown in the slide.
If during ROP screening, no signs of retinopathy of prematurityis present and retina is fully vascularized, then babies should have a visual follow up at 4 and 9 months of age. If Retina is avascular in Zone 2 and 3 then frequency of screening should be every 2-3 weeks till retina is fully vascularized. If Retina is avascular in Zone 1, then these babies should be followed more frequently that isevery 1-2 weeks. If ROP is present: then subsequent follow up, depends upon the zone and stage of ROP. In Zone 1, stage 1 or 2 ROP without plus disease the follow up interval is every 1 week and if there is regressing ROP: follow up interval is 1-2 weeks In Zone 2 ROP IF there is Stage 1 follow up interval is 2 weeks and if there is Stage 2 follow up interval is 1-2 weeks and if there is Stage 3 then follow up interval is 1 week or less and if there is regressing ROP then follow up interval is 2 weeks In Zone 3 ROP if there is Stage 1 or 2 and regressing ROP follow up interval is 2-3 weeks
Having learnt about retinopathy of prematurity screening process, it is important to know that how linking with Rashtriya bal swasthya karyakram that is RBSK, will help us to improve ROP screening programme. Linking with RBSK will lead to improve coordination and financial support. There will be adequate provision of equipment to screen and treat ROP. Long term follow up along with rehabilitation and referral servicescan be streamlined by involvement of frontline health workers like ASHA
So we have learnt that: ROP screening should be done at 4 weeks after birth. However, in babies born earlier than 30 weeks gestation or birth weight less than 1200 grams, it should be done at 2-3 weeks after birth. The screening should be done by trained ophthalmologists using indirect ophthalmoscope. The frequency of follow up depends upon the zone and stage of ROP
  • Introduction...
  • 1. Learning object...
  • 2. Whom to screen?...
  • 3. When to screen?...
  • 4. ROP screening: ...
  • 5. Preparation of ...
  • 6. Preparation of ...
  • 7. Planning follow...
  • 8. Linking with RB...
  • 9. Key messages...
 

Introduction

DR. AMANPREET SETHI
MD, DM (Neonatology)

Assistant Professor
Department of Pediatrics
All India Institute of Medical Sciences
New Delhi

1. Learning objectives

â–º Whom to screen?

â–º When to screen?

â–º Who will screen?

â–º How to prepare a baby for screening?

â–º How to plan follow up?

2. Whom to screen?

Infants with either of the following
   ♦ Birth weight less than 2000 grams OR
   ♦ Gestation age less than 35 weeks OR

Any preterm infant with following risk factors
   ♦ Cardio-respiratory instability
   ♦ Prolonged oxygen therapy
   ♦ Repeated episodes of apnea of prematurity
   ♦ Blood transfusion
   ♦ Sepsis
   ♦ Poor postnatal weight gain

3. When to screen?

â–º First screening at 4 weeks of age

â–º For infants between 24-30 weeks GA /Birth weight < 1200
    gram: 2-3 weeks after delivery (Not later than 3 weeks)

4. ROP screening: Place, person and equipment

5. Preparation of babies prior to screening

6. Preparation of babies prior to screening 2

7. Planning follow up interval

8. Linking with RBSK

â–º Improve coordination and financial support

â–º Provision of equipment to screen and treat

â–º Long term follow up can be streamlined by involvement
    of front line health workers

â–º Improvement of rehabilitation/referral services

9. Key messages

â–º ROP screening should be done at 4 weeks after birth

â–º Infants born earlier than 30 weeks/ birth weight <1200
    grams: do examination at 2-3 weeks

â–º The screening should be done by trained
    ophthalmologists using indirect ophthalmoscope

â–º The frequency of follow up depends upon the zone and
    stage of ROP