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Knowledge gap among nurses related to retinopathy of prematurity and its prevention and management

Walinjkar, Jaydeep Avinash

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Indian Journal of Ophthalmology: August 2021 - Volume 69 - Issue 8 - p 2125-2126
doi: 10.4103/ijo.IJO_623_21
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Retinopathy of prematurity (ROP) management is done by trained retina specialists or optometrists trained for taking the Retcam images. It needs a special skill set. The nursing staff in neonatal intensive care unit (NICU) have very little role to play in the management of ROP. They are only required to know about the dilatation protocol and to assist the specialist during the examination. Follow-ups and management differ from baby to baby, depending not just on the ocular findings but also on the general health status, birth weight, blood transfusion, and various other factors.[12] Follow-ups are decided by the specialists and conveyed to the nursing staff and pediatrician. The nursing staff has very little role to play in the same.

Authors in this study have based their results on a questionnaire evaluating the knowledge of ROP among the nursing staff in a NICU setup. The prevalence of ROP in that NICU, its management, or success rate is not included in this study. It is not possible to form any conclusions regarding the management of ROP in a NICU based on the theoretical knowledge of the nursing staff.

This study can, at the most, conclude that the nursing staff in this particular NICU needs further education on ROP.

Regarding a disease that needs very skilled and intricate management, there is little contribution that can be provided by the nursing staff for the active management of the disease perse. Their contribution is more valuable in following the specific dilatation protocol and also for assisting in the examination and practical aspects of it,[345] which according to this study, the nursing staff was well trained in.

All the participants involved in the study were able to define ROP, identify the listed risk factors associated with ROP, and could advise parents appropriately for keeping the neonate nil per oral (NPO) for ROP examination. The present study showed that most of the participants were able to give correct answers on the relationship between the incidence of ROP and gestational age and birth weight of newborn, indications of ROP screening in newborns, gestational age at which the first screening examination for ROP should be carried out, the concentration of eye drops used for dilating the eye before the eye examination and the time interval for dilating the eyes of a neonate before an examination, and for follow-up and laser therapy as the most preferred method for peripheral retinal ablation. The key factors in the outcome of ROP from a given list (stage of ROP, early diagnosis and treatment, severity of ROP, and early discharge from hospital) and the name of the instrument used during the ROP treatment were correctly responded to. The study also concluded that the reasons for having high score in these items could be that the nurses were more practically oriented and were well versed with the tasks they were performing routinely.

More detailed knowledge is definitely good, but might not prove very helpful in this particular disease management.

Since it is not a multicenter study, it has very poor reliability when it comes to generalization across all such centers. It is not possible to draw a valid conclusion based on this study.

Also, in the discussion, there has not been a significant comparison between similar studies (only one is quoted) and the reason for the differences is not quite explained.[6] It would have been more preferable to quote more articles or studies on the same topic and also to discuss the results and the reasons for their differences or similarities. The discussion seems quite inadequate and the author is not able to validate the study results.

The key factor for determining the inappropriate management of ROP in the mentioned settings would be including the neonatologists/pediatricians who would be actually referring the babies for ROP screening as they play a crucial role in this regard. Conducting a study among the pediatricians/neonatologists would have been a better option than the nursing staff.[78]

Also, it would have been meaningful to have a time period of 1 year where one would evaluate how many ROP babies from this center were referred on time for ROP screening and how many got delayed resulting in complications. And a separate questionnaire to be administered to the nursing staff and pediatricians at the end of this period. Only then, can we correlate the lack of/poor knowledge regarding ROP to the poor management/increased incidence of ROP.

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2. Gilbert C. Retinopathy of prematurity:Aglobal perspective of the epidemics, population of babies at risk and implications for control Early Hum Dev. 2008;84:77–82
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