Neonatal Survival and Risk Factors for Retinopathy of Prematurity among Infants Admitted in Tertiary Hospitals, Northern Tanzania

Abstract

Background: Retinopathy of prematurity is a preventable cause of childhood visual impairment, particularly among premature infants who survive after neonatal intensive care. Improved neonatal care in low- and middle-income settings may increase the number of infants at risk, making local data on survival, incidence, and associated factors important for planning screening services. Aim: This study assessed neonatal survival, the incidence of retinopathy of prematurity, and associated neonatal and maternal factors among premature infants admitted to tertiary hospitals in Northern Tanzania. Methods: A hospital-based prospective cohort study was conducted among premature infants with gestational age below 37 weeks and/or birth weight below 2500 g admitted to Kilimanjaro Christian Medical Centre and Arusha Lutheran Medical Centre. Eligible infants underwent retinal examination, and findings were classified according to the International Classification of Retinopathy of Prematurity. Data were analysed using descriptive statistics and Fisher’s exact test to assess associations between selected risk factors and retinopathy of prematurity. Results: Seventy premature infants were enrolled. Eleven infants died before completing 28 days of life, and the reported neonatal survival proportion was 84.2%. Retinopathy of prematurity was reported in 11 infants, representing 20.0% of the analytic sample. All affected infants had bilateral disease; nine had stage 1 disease and two had stage 2 disease. No infant developed stage 3, 4, or 5 disease, and all cases regressed completely during follow-up. Lower birth weight, neonatal infection, more than one blood transfusion, and maternal pre-eclampsia were significantly associated with retinopathy of prematurity. Conclusion: In this cohort, neonatal survival was high and one-fifth of assessed infants developed mild to moderate retinopathy of prematurity. The findings support continued retinal screening among premature infants and careful monitoring of infants with low birth weight, neonatal infection, repeated blood transfusion, or exposure to maternal pre-eclampsia.