Overall care of newborn should be improved to prevent Retinopathy of Prematurity (ROP). Timely screening is very important to prevent blindness.

1. Dr. Arijit Bhowmik
MD, DNB Pediatrics
Assistant Professor
Department of Neonatology
Medical College and Hospital, Kolkata

2. Major risk factors for the
development of ROP
 Premature birth
 Low birth weight
 Supplemental oxygen exposure
 Respiratory distress, breathing difficulties
 Sepsis
 Poor weight gain
 Blood transfusions
 Overall health of the infant

3. Oxygen
 Hyperoxemia, hypoxemia, and substantial fluctuations
in oxygen saturation are all correlated with the
development of severe ROP.
 Trials (SUPPORT, BOOST-II), to determine the
appropriate oxygen levels needed to lower the risk of
ROP, shows at lower saturation level (85-89%)
incidence of severe ROP was lower but mortality was
higher as compared to higher saturation level (91-
95%).

4.  Overall, the optimal oxygen saturation levels to
minimize severe ROP risk, as well as mortality, have
yet to be determined.
 Raghuveer et al. suggested titrating oxygen saturation
levels such that the infant is maintained under
gradually increasing oxygen saturation levels as
postmenstrual age increases to avoid early hyperoxia
and later hypoxia.

5.  Prolonged mechanical ventilation is an independent
risk factor for ROP
 Long-term use of a CPAP is predictive of treatment-
requiring or severe ROP
 The early administration of postnatal corticosteroids
within the first seven days of life has been shown to
decrease rates of ROP, including severe ROP, whereas
late administration (after the first seven days of life)
increased overall rates of severe ROP.

7. POINTS of Care
 Pain: Avoid and prevent painful episodes.
 Oxygen management: Ensure recommended oxygen
saturation.
 Infection control
 Nutrition: Improved nutrition with breast milk
 Temperature control
 Supportive care: Includes good positioning of the baby
in an incubator or cot and the use of kangaroo care
 Other: Minimise blood transfusions. Reduce blood
sampling and the volume of blood taken.

8. General nonpharmacological
measures of pain management
 Avoid bright light, loud noise
 Limit the number of painful procedures and handling
 Bundling of investigations and nursing interventions
 Swaddling, facilitated tucking
 Sucrose/glucose solution induced analgesia
 Breast feeding/breast milk supplementation
 Skin to skin care
 Non-nutritive sucking using pacifiers

9. Oxygen management
 Oxygen level in blood should be continuously
monitored using pulse oximetry keeping a saturation
target of 90% to 93%, with limits set at 88% and 95%.

10. Infection control
Infection control
protocol and
proper hand
washing by all is
essential part of
all SNCU/NICU

11. Nutrition
Mothers' own
breast milk
fortified with
extra protein and
calories are
essential for
proper growth
and ROP
prvention

12. Temperature control
 Early skin to skin contact
 Maintaining room temperature
 Thermoneutral environment in radiant
warmer/incubator.

13. Supportive
care

14. Packed cell transfusions guideline:
 Ventilated infants: Hct < 40%
 Infants with cardio-pulmonary disease but not on
ventilators: Hct < 35%
 Sick infants but no cardiopulmonary instability: Hct <
30%,
 Symptomatic anemia: Hct < 25%
 Asymptomatic anemia: Hct < 20%.

15. Adherence to ROP screening
protocol
 Written protocol for ROP screening and treatment.
 First screening should be done before discharge
 If discharge done before first screening, then to ensure
proper follow up for screening

16. References
1) Guidelines for Universal Eye Screening in Newborns Including
RETINOPATHY OF Prematurity Rashtriya bal swasthya karyakram
Ministry of Health & Family Welfare Government of India June 2017.
2) Deorari A, Darlow BA. Preventing sight-threatening ROP: a
neonatologist's perspective. Community Eye Health. 2017;30(99):50-
52. PMID: 29434436; PMCID: PMC5806218
3) Prasad, Minali, Ellen C. Ingolfsland, and Stephen P. Christiansen.
2023. "Modifiable Risk Factors and Preventative Strategies for Severe
Retinopathy of Prematurity" Life 13, no. 5: 1075.
4) Wang, H.; Zhang, S.X.; Hartnett, M.E. Signaling Pathways Triggered
by Oxidative Stress That Mediate Features of Severe Retinopathy of
Prematurity. JAMA Ophthalmol 2013, 131, 80–85.
5) The STOP-ROP Multicenter Study Group. Supplemental Therapeutic
Oxygen for Prethreshold Retinopathy of Prematurity (STOP-ROP), A
Randomized, Controlled Trial. I: Primary
Outcomes. Pediatrics 2000, 105, 295–310

17. Thank you