Mobile unit for retinopathy of prematurity screening and management at urban Neonatal Intensive Care Units: Outcomes and impact assessment

Abstract

Purpose: To study the outcomes and impact of a mobile unit for retinopathy of prematurity (ROP) screening and management at urban Neonatal Intensive Care Units (NICUs). Study Design: Public health intervention study. Methods: This study was conducted in 2012. Staff of a mobile unit assessed all infants aged 32 weeks or less and/or weight 1250 g or less admitted in five NICUs between 2009 and 2011. An ophthalmologist performed bedside ROP screening through dilated pupils using indirect ophthalmoscopy. ROP was graded and managed as per the International Classification of ROP treatment guidelines. Counseling and laser treatment were the interventions. The incidence, grade, and determinants of ROP were estimated. Direct and indirect costs were calculated to estimate the unit cost of screening and managing a child with ROP using the mobile unit. Result: The study sample included 104 preterm/underweight infants. The prevalence of ROP of different grades in either eye was 32.7% (95% confidence intervals: 23.7-41.7). ROP Stage I was present in 75% of these eyes. The mobile unit could help in preventing/reducing visual disability in 5 infants with advanced stages of ROP. The unit cost of ROP screening, identifying one child with ROP, and addressing visual disability due to ROP was US $310, 950, and 6500, respectively. Conclusion: A mobile screening is likely feasible and cost-effective method to detect ROP and offer timely intervention in urban areas with limited resources.