Tuesday 17 May 2016

Retinopathy of Prematurity

Retinopathy of Prematurity - Screen all infants with a birth weight less than 1.5 kg or gestational age less than 32 weeks for retinopathy of prematurity between 2-4 weeks after birth A premature infant is not born with Retinopathy of Prematurity (ROP). The retina though immature is normal for this age. The ROP usually starts developing 2-4 weeks after birth when it is mandatory to do the first screening of the child. The current guidelines are to examine and screen the babies with birth weight<1500g and ><32 weeks gestational age, starting at 31 weeks post-conceptional age (PAC) or 4 weeks after birth whichever is later. Around a decade ago, the guidelines in general were the same and the premature babies were first examined at 31-33 weeks post-conceptional age or 2-6 weeks after birth. Despite the ongoing interest world over in screening and management of ROP and advancing knowledge, it may not be possible to exactly predict which premature baby will develop ROP and to what extent and < 1.5 kg or < 32 weeks of gestation starting at 31 weeks post-conceptional age or 4 weeks after birth whichever is later. Around a decade ago, the guidelines in general were the same and the premature babies were first examined at 31-33 weeks post-conceptional age or 2-6 weeks after birth. In July 2015, the Supreme Court of India ordered the Tamil Nadu State Government to pay a sum of Rs 1.8 crores to an 18-year-old girl who lost her vision at birth. The 1.25 kg baby girl was born prematurely (29 weeks) and was placed in an incubator in ICU for 25 days. She was administered 90-100% oxygen at the time of birth and underwent blood exchange transfusion a week after birth. The baby and the mother came for a follow-up at the chronological age of 9 weeks. The preventable ROP was not screened. In May 2016, the National Consumer Disputes Redressal Commission (NCDRC) awarded Rs 64L as compensation in a decision against Maharaja Agrasen Hospital in Delhi and three of its doctors for not screening ROP in a baby who had been in the hospital for nearly 5 weeks. The Forum said in its order: o “No record means, it was not done'. o The nurses' daily record does not show any ROP examination was done o The patient visited hospital for follow up, but nothing is in record about ROP testing.”

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