ROP screening and treatment in four district-level special newborn care units in India: a cross-sectional study of screening and treatment rates

OBJECTIVE: Blindness from retinopathy of prematurity (ROP) in middle-income countries is generally due to absence of screening or inadequate screening. The objective of this study was to assess uptake of services in an ROP programme in four district-level special newborn care units in India. DESIGN: Cross-sectional study. SETTING: All four neonatal units of a state in India where model programme for ROP had been introduced PATIENTS: Infants eligible for screening and treatment of ROP between March and May 2017. INTERVENTION: Data on sex, birth weight and gestational age of eligible infants were collected and medical records reviewed for follow-up. MAIN OUTCOME MEASURES: Proportion of eligible infants screened and for those screened, age at first screening, completion of screening, diagnosis and treatment received if indicated. The characteristics of infants screened and not screened were compared. RESULTS: 137 (18%) of the 751 infants eligible for screening were screened at least once, with no statistically significant difference by sex. The mean birth weight and gestational age of those screened were significantly lower than those not screened. Among those screened, 43% underwent first screening later than recommended and 44% had incomplete follow-up. Fourteen infants (11% of those screened) were diagnosed with ROP. Five were advised laser treatment and all complied. CONCLUSION: Uptake, completion and timing of first screening was suboptimal. Some planned interventions including training of nursing staff, use of integrated data-management software and providing material for parent counselling, which have been initiated, need to be fully implemented to improve uptake of ROP screening services.