Retinopathy of prematurity in India: incidence, risk factors, outcome and the applicability of current screening criteria

Background: To study the incidence, risk factors and outcome of retinopathy of prematurity (ROP) in at-risk newborns at tertiary care hospital in Vadodara.Methods: Preterm infants with birth weight ?2000 gm and gestation ?34 weeks were screened for ROP at 4 weeks of birth for first screening or if <28 week or <1200 grams then at 3 weeks after delivery. Infants with birth weight >2000 gm and gestation >34 weeks were screened only if they had additional risk factors. Those found to have high risk ROP were treated.Results: The incidence of ROP in 286 infants who were screened was 24.1%, 12 ROP positive cases were having birth weight >2000 gm. On multivariate analysis risk factors predisposing to ROP (P<0.05) were birth asphyxia, Sepsis, multiple blood transfusion, respiratory distress syndrome, multiple birth, antenatal steroid use and Phototherapy. Out of 69 infants who developed ROP, 6(8.7%) needed invasive management.Conclusions: Risk factors predisposing to ROP were gestational age and birth weight alone and along with the various risk factors like birth asphyxia, sepsis, multiple blood transfusion, respiratory distress syndrome, multiple birth, antenatal steroid use and phototherapy. The occurrence of ROP is trending towards a rise including newborns with higher birth weight and gestational age in developing countries; hence necessitating to use different guideline for Screening of Newborns in these developing countries.

Current status of polio eradication and future prospects.

The launch and the progress of global polio eradication initiative lead to a world wide decline of polio cases during the last few years. India shared this progress till 2001, when the number of reported cases were 268. Reversing this trend India reported 1599 cases during 2002 thereby accounting for nearly 87% of cases detected globally. Strategies for polio eradication are being revised after realizing that strategies such as fixed booth approach have not been sufficient to interrupt wild polio virus transmission. Increased number of NIDs and additional SNIDs are being planed to reach the previously unreached children. Low literacy levels, high poverty and resistance for OPV immunization in certain areas has further compounded the problem. As the progress in India is critical for the global polio eradication, maintenance of high routine immunization coverage, monitoring of SIA quality, AFP surveillance and laboratory investigations are vital for a successful outcome of this initiative.

Controversies in polio immunization.

Vaccines against poliomyelitis have been in use for nearly five decades now and have played a major role in progress towards global eradication of the disease. Both the vaccines, (oral polio vaccine and inactivated polio vaccine) and their uses are still debated with particular reference to their selective advantages vs. disadvantages, choice for individual vs. community protection and their administration strategies. Further occurrence of vaccine associated paralytic poliomyelitis with oral vaccine assumes importance in the face of disappearing disease. Further availability of inactivated polio vaccine in India and its various schedules such as sequential and combination schedules show some promise for polio eradication.