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Abstract Background: The improvement in neonatal care during the last decades in Egypt leads to improved survival of preterm babies. This directly raised the incidence of ROP and its related adverse sequels.The prevention of ROP related blindness depends mainly on screening and early detection of sight threatening disease in high risk groups of preterm. That is why providing proper screening and identification of related risk factors are important steps for achieving this goal. Objective:to study the demographics and epidemiology of ROP in preterm infants from three selected Egyptian governorates, Gharbia, Kafr El-Shiekh and Al-Buhaira. Also, to study the possible risk factors for the development of ROP and the requirements for treatment. Patients and methods: The study enrolled 300 preterm babies from 3 different governorates for ROP screening and risk factors identification. Those with GA {u2264}32 weeks and/or BW {u2264} 1500 g were included. In addition to those with GA> 32 weeks and/or BW >1500 g and had unstable clinical course. Infants with media opacities were excluded. Demographic data and possible risk factors were collected. Results: The mean GA and BW of studied preterm were 31.9 ± 2.03weeks & 1484.05 ± 316.71 g respectively. The study revealed 80% overall incidence of ROP. Treatment requiring ROP was found in 22.9% of all ROP cases. Lower GA and BW, Apnea, AF, RBCs infusion and BPD were the most relevant risk factors |