Retinopathy of Prematurity: An Approach to Control the “Third Epidemic” in Argentina

Presenter: Celia Lomuto, ROP Group – National Health Ministry

Background: Retinopathy of prematurity (ROP) is the leading cause of childhood blindness in Argentina. It is closely related to the increase survival of preterm newborns and also with care deficits in NICUs, resulting in high rates of ROP in patients with higher birth weight (BW) and gestational age (GA), and missed opportunities (MO). In 2004, a national program with active participation of nurses, neonatologists and opthalmologists was established gradually to prevent, diagnose and treat ROP with UNICEF support.

Methodology:  Multicentric, consecutive cross sectional studies with the objective of analysing the impact of the national program in the detection and treatment of ROP from 2004 to 2013. Population included: all preterm babies who were born in 70 Neonatal Units with BW <1,500 g and/or ≤ 32 w GA, and preterms ≥1,500 g and/or 33-36 w who received oxygen therapy or were exposed to risk factors (unusual cases).

Results: Severe grades decreased 40% and screened newborns increased 2½ times. In treated cases, BW average decreased from 1310 g to 1077 g, and GA from 31 w to 29 w. ; UC was halved (30% to 16,5 %). Prevalence of ROP is still high in <1,500 g: 36% any ROP, 9.5% severe ROP and MO 20 cases in 10 years. Ophthalmologic screening was 100% in <1,500 g; 90% in preterms with risk factors. Newborn location at treatment increased from 57 to 86%. The enrolment at schools for the blind and visually-impaired by sequel of ROP decreased from 50% (2004) to 23.7% (2013) at the same schools.

Conclusion: In spite of improvements observed in diagnosis and treatment, ROP is still a health problem in Argentina, especially in prevention, eg: oxygen administration control. In developing countries, criteria for screening and training programs should be designed according to local or regional conditions.