Initiating Retinopathy of Prematurity Screening before Discharge from the Neonatal Care Unit: Effect on Enrolment in Rural India

OBJECTIVE: To compare the benefits of initiating Retinopathy of Prematurity (ROP) screening at first contact with the admitted infant prior to hospital discharge ('early screening') with screening performed between 21 and 28 days after birth ('conventional screening') in rural India. DESIGN: Prospective study. SETTING: Two Level II neonatal intensive care units (NICU), from two district headquarters in Karnataka state. PARTICIPANTS: Participants: 329 infants admitted in the two NICUs. INTERVENTION: One NICU was randomly selected for 'early' and the other for 'conventional' screening. Infants <2000 g at birth were targeted for enrolment. Both centres were visited once a week by a dedicated ROP team. MAIN OUTCOME MEASURE(S): The yield of enrolment, and the magnitude of treatment-requiring cases that would be missed in each scenario were estimated and compared. RESULTS: 107 of 329 admitted infants were eligible for ROP screening. In the study period of 4 months, 42 and 65 infants were eligible for enrolment in the early and conventional group, respectively. In the early group, 88.1% of eligible infants got screened, compared to 38.5% in the conventional group (P=0.03). CONCLUSION: Early enrolment of infants for ROP screening in the NICU itself ensures a superior yield compared to conventional age of initiating screening. The recorded information of mothers allowed pre-counselling, improved enrolment and better compliance to the scheduled examinations. These results suggest the need to re-look at the screening guidelines in India and other regions with similar demographics.