ABSTRACT
Objective@#To assess the level of awareness and practice patterns of pediatricians in various government and private hospitals in the Philippines regarding retinopathy of prematurity (ROP).@*Methods@#This is a prospective, multicenter, cross-sectional study of the practice profile and awareness of pediatricians of the Philippine Pediatric Society (PPS) ROP screening recommendations. Six hundred selfadministered questionnaires were distributed to pediatricians from 40 randomly selected government and private hospitals in the Philippines between July and September 2013. Frequency distribution for each data was noted. Association of referral rates, distribution of barriers, and availability of protocol among the subgroups were analyzed using chi square.@*Results@#A total of 409 eligible surveys were analyzed with a response rate of 68.1%. 92% of the respondents referred their at-risk preterm babies to ophthalmologists for ROP screening. Of those who referred, 57% considered a cut-off value of less than 32 weeks age of gestation, and 45% considered a cut-off value of less than 1500g birth weight. 47% referred at 4-6 weeks post-natal age, and 48% had a protocol for ROP screening. Only 19% were aware of the PPS ROP screening recommendations. The major barrier encountered was the inability of the families to follow up after discharge (41%). Higher referral rates were noted from private institutions (p=0.013) and tertiary hospitals (p=0.019), including those with a protocol on ROP screening (p=0.002).@*Conclusion@#Majority of the respondents referred their at-risk preterm babies for ROP screening. A significant proportion was unaware of the PPS ROP screening guidelines. More than half do not have an established protocol. There were variations in practice patterns of the pediatricians in referring babies at-risk for ROP. Based on these, there is still a need to increase awareness among pediatricians. A uniform, national, published guideline on ROP screening, establishment of referral systems, and training of qualified ophthalmologists are recommended.
Subject(s)
Retinopathy of Prematurity , Mass Screening , Surveys and QuestionnairesABSTRACT
Objective@#(1) To determine if preterm babies with ROP are missed with the existing Philippine Pediatric SocietyPhilippine Academy of Ophthalmology 2005 screening criteria of ≤32 weeks gestational age (GA) and ≤1,500 grams birth weight (BW), (2) to determine the incidence (missed-out rate) of these babies with ROP (>32 weeks GA, >1,500 grams BW), (3) to describe their profile, and (4) to determine the appropriate upper limit for GA and BW that can provide safe and efficient screening for severe ROP.@*Methods@#This is a multicenter, retrospective cohort, observational study using data on ROP screening from the medical records of preterm babies from 4 institutions. All babies born ≤36 weeks GA, regardless of BW, who previously underwent ROP screening in 2011-2013, were included. Outcome measures were: (1) missed-out rate, (2) profile of missed babies with ROP (GA, BW, and risk factors), and (3) the proposed new criteria.@*Results@#Of the 762 babies screened, 105 (13.8%) had ROP. Of these, 13 (12%) had severe ROP, 28 (27%) was born at 33-36 weeks GA, and 32 (30%) with >1,500 grams BW. The oldest and heaviest of these missed babies with type 1 ROP was almost consistently reported at <35 weeks GA and <2,000 grams BW. Associated significant risk factors seen among missed babies were sepsis, respiratory distress syndrome (RDS), oxygen supplementation, and blood transfusion. There were 45 babies (43%) with ROP but with no risk factors. Among these were babies with GA >32 weeks and BW >1500 grams with ROP. The incidences of ROP, with and without risk factors, in the 4 institutions were not statistically significant. Seventeen (16.2%) preterm babies were missed with the existing criteria. Two of these had no risk factors but had type 1 and type 2 ROP. When <35 weeks GA and <2,000 grams BW as the new criteria were applied, the missed-out rate was reduced to 2% and was further reduced to zero with the inclusion of risk factors.