Multicentre survey of retinopathy of prematurity in Indonesia.

Background: The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants. Objective: To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia. Setting: Data were collected from 34 hospitals with different levels of care: national referral centres, university-based hospitals, and public and private hospitals. Methods: A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016-2017 in relation to gestational age and birth weight. Results: We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28-32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%-5%. Both mortality and the incidence of ROP were highest in university-based hospitals. Conclusions: In the 2016-2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016-2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia.

Norrie disease gene polymorphism in Indonesian infants with retinopathy of prematurity.

OBJECTIVE: Retinopathy of prematurity (ROP) is a major cause of blindness in newborn infants, which also occurs in low-income and middle-income countries. Why ROP progresses in some infants while it regresses in others is still presently unknown. Studies suggest that genetic factors might be involved. Mutations in the Norrie disease (ND) gene are suspected to be related to advanced ROP development. Indonesia is a country with relatively high incidence of ROP, yet the role of these genetic factors in the pathogenesis of ROP cases is still unknown. The study aimed to investigate the presence of mutations in ND on the X chromosome in infants with both non-advanced and advanced ROP in Indonesia. METHODS AND ANALYSIS: This is a case-control study of polymorphisms in six variants within the ND gene in exon 3, C597A, L108P, R121W, A105T, V60E and C110G, in preterm newborn infants in four major hospitals in Greater Jakarta, Indonesia. RESULTS: We included 162 preterm newborn infants. ROP was diagnosed in 83 infants, and 79 infants served as controls. Among those with ROP, 57 infants had type 2, while others had type 1. We did not find any gene polymorphisms in any of the infants with ROP nor in the control group. CONCLUSION: We conclude that it is very unlikely that the six polymorphisms in exon 3 of the ND gene studied in this paper are involved in the development or progression of ROP in preterm infants in our population sample in Indonesia.

Eleven years of retinopathy of prematurity in one neonatal intensive care unit in Jakarta, Indonesia.

BACKGROUND: Retinopathy of prematurity (ROP) is a well-known complication in preterm infants. Data on the incidence of ROP in Indonesia, in relation to birth weight (BW) and gestational age (GA), are limited. OBJECTIVE: To report the incidence of ROP in one of the oldest and largest neonatal intensive care unit (NICU) in Indonesia. METHODS: We studied the incidence and severity of ROP in inborn infants with a BW of ≤1500 g and/or GA of ≤32 weeks, who were admitted to the NICU of Harapan Kita Women and Children Hospital, Jakarta. In addition, infants with a higher BW and GA, receiving more than 40% oxygen for a longer period, were screened. RESULTS: In 2005-2015, 182 infants were born with a BW of <1000 g and 437 with a weight of 1000-1500 g. In the <1000 g group, 27 (46%) of the screened infants showed no ROP, 22 (37%) showed ROP 1-2 and 10 (17%) showed ROP 3-5. In the 1000-1500 g group, 172 (68%) were without ROP, 71 (28%) with ROP 1-2 and nine (4%) with ROP 3-5. Twenty-two (13%) of the 163 screened infants weighing 1500-2000 g showed ROP 1-2 and two (1.2%) had ROP 3-5. Eight (18%) of the 44 screened infants born with a BW of more than 2000 g showed ROP 1-2 and none showed ROP 3-5. CONCLUSION: The total incidence of ROP as well as severe ROP in infants with a BW of <1000 g and 1000-1500 g in our NICU is higher than in a developed country. ROP in Indonesia is also seen in infants with a BW of 1500-2500 g. Increasing the awareness of the risks of oxygen as well as better equipment to monitor oxygen delivery is essential.