Kangaroo Program:
Retinopathy of Prematurity

Jenniffer Solivan M.D.

 

Objectives:

1.     Gain an understanding of the current ROP situation in Dominican Republic

-Mapping of resources, caseload and infrastructure per city and hospitals.

-Prioritize according to needs and volume of high risk newborns.

2.     Stablish strategies for Primary/ Secondary prevention

-Reduction of risk factors that will lead to preterm pregnancy: adolescent pregnancy, underweight, chronic health condition, infections, substance abuse, small interval between births, smoking.

-Proper screening and management of pregnant women with high risk of preterm pregnancies: multiple pregnancy, diabetes, and hypertension.

-Use of antenatal corticosteroids

3.     Follow guidelines for after birth prevention of ROP

-Avoid unmonitored 100% oxygen supplementation to newborns.

-Maintenance of adequate caloric intake during first few weeks.

-Provide resuscitation, breast milk and kangaroo care as soon as possible and as long as possible while the infant is in the neonatal care unit.

4.     Adoption and implementation of an effective screening strategy that begins since the first hours of neonatal intervention.

5.     Introduction of Telemedicine screening approach:

-Multidisciplinary approach from various health and non-healthcare professionals.

6.     Implementation of more affordable and portable ROP smartphone lenses cameras for usage by nurses, pediatricians or neonatologist in the institution.

-Mobile, non-contact device that captures good bedside fundus images of ROP infants.

-Training and certification of imagers.

7.     Create a network of ophthalmologist inside or outside the country that will review the images taken by the trained imagers.

-Required to grade the images and stablish an algorithm of priority :

o   red – requires immediate treatment or review

o   yellow – immature or diseased retina (requires follow up)

o   green – mature ( no need for follow up)

8.     Stablish protocol for referral and treatment based on severity.

9.     Counseling and education of parents and health workers in the importance of follow up screening and management.

10.  Create steps and strategies for rehabilitation, vision stimulation and treatment techniques.

Possible challenges:

  1. Some preterm pregnancies are non-preventable.

  2. The lack of resources in many institutions in the Dominican Republic.

  3. Lack / shortage of ophthalmologist.

  4. Lack of medical personal available to perform the role of the imager.

  5. Lack of education about the importance of screening for ROP in parents and healthcare workers.

  6. Loss of mothers and infants due to lack of follow up.

  7. Challenges of the families to commute to the treatment and screening facilities.

  

References:

  1. Azad, Rajvardhan FRCS, MD; Gilbert, Claire FRCO, MD; Gangwe, Anil B. MD; Zhao, Peiquan MD, PhD; Wu, Wei-Chi MD, PhD; Sarbajna, Puja BOT, MOT; Vinekar, Anand MD, PhD Retinopathy of Prematurity: How to Prevent the Third Epidemics in Developing Countries, Asia-Pacific Journal of Ophthalmology: September-October 2020 - Volume 9 - Issue 5 - p 440-448

  2. Gilbert, C., Wormald, R., Fielder, A., Deorari, A., Zepeda-Romero, L. C., Quinn, G., Vinekar, A., Zin, A., & Darlow, B. (2016). Potential for a paradigm change in the detection of retinopathy of prematurity requiring treatment. Archives of disease in childhood. Fetal and neonatal edition, 101(1), F6–F9. https://doi.org/10.1136/archdischild-2015-308704

  3. Goyal, A., Gopalakrishnan, M., Anantharaman, G., Chandrashekharan, D. P., Thachil, T., & Sharma, A. (2019). Smartphone guided wide-field imaging for retinopathy of prematurity in neonatal intensive care unit - a Smart ROP (SROP) initiative. Indian journal of ophthalmology, 67(6), 840–845. https://doi.org/10.4103/ijo.IJO_1177_18

  4. Kelkar, J., Kelkar, A., Sharma, S., & Dewani, J. (2017). A mobile team for screening of retinopathy of prematurity in India: Cost - effectiveness, outcomes, and impact assessment. Taiwan journal of ophthalmology, 7(3), 155–159. https://doi.org/10.4103/tjo.tjo_48_17

  5. Senjam, S. S., & Chandra, P. (2020). Retinopathy of prematurity: Addressing the emerging burden in developing countries. Journal of family medicine and primary care, 9(6), 2600–2605. https://doi.org/10.4103/jfmpc.jfmpc_110_20

  6. Vinekar A. (2018). Screening for ROP. Community eye health, 31(101), S8–S9.