Initiating retinopathy of prematurity screening in a tertiary care hospital in a resource-constrained setting: challenges and outcomes

Introduction: Retinopathy of prematurity (ROP) affects preterm infants with less than 2000 grams and a gestational age of 35 weeks or less, who are treated in the Neonatal Intensive Care Unit (NICU). The sequelae of ROP can be prevented by a meticulous screening program, which is the need of the day in Low- and Middle-Income Countries (LMICs) like Pakistan. Objectives: To evaluate the burden of ROP and the challenges encountered during the screening of ROP in a tertiary care hospital of Peshawar, Pakistan. Materials and Methods: This cross-sectional study was conducted in the MTI Lady Reading Hospital, Peshawar Pakistan, between May 2022 and June 2024. All the preterm infants (n=501) born before the gestational age (GA) of 35 weeks and/or with birth weight of less than 2000 grams, and who were exposed to uncontrolled Oxygen in NICU care, were included. Dilated fundoscopy was done to determine the presence or absence and the stage of ROP by a pediatric ophthalmologist. The screening results and the difficulties encountered during the initiation of the program were assessed. Results: Out of 501 enrolled preterm infants 349 (≈ 70%) babies expired before undergoing screening. Among the remaining 152 neonates who were screened, ROP was detected in 16.4%. Additionally, 17.2% of the screened infants required follow-up and observation, while 8.3% were referred for further treatment. The primary challenges faced were poverty (45.5%), poor parental compliance (15.3%) and inadequate coordination by the healthcare coordinator (15.3%). Conclusion: The initiation of ROP screening in a resource-constrained hospital has multifactorial challenges with its success dependent on the commitment of all stakeholders.