Steps to Prevent Blindness due to ROP in Lima Peru ORBIS Project (August 2007 – Nov 2011) IAPB 9 General Assembly - Hyderabad, India September 17-20, 2012 Dra. LUZ J. GORDILLO R. Ophthalmologist

Dra. Ana M. Villanueva E. Neonatologist

INSTITUTO DAMOS VISION

# of cases

Blind Children Due to ROP without any Evaluation that Arrive to IDV 18 16 14 12 10 8 6 4 2 0

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 # ciegos por ROP

Source: Instituto Damos Visión PERU

Lineal (# ciegos por ROP)

PROFILE OF CHILDREN BLINDNESS DUE TO ROP IN PERU

ANALISYS OF BLINDNESS DUE TO ROP BY BIRTH WEIGHT GROUPS 1995 - 2009

4

5

20 N = 91 cases

13

3

II

# babies per nurse in Intermediate Care

4

5a6

>6

III

# babies per air compressed point

1

>1

No air

IV

O2 moist, warm, stable and regulated concentration.

SI

NO ó discontinuous

NO

V

# oxygen analyser per baby in oxygen therapy

1

1 for 4

>4

VI

# of pulsioximeter per baby

1

2a3

More than 3

VII

# mechanical ventilator x each/1000 births in a year.

>1

1 a 0,6

< 0,5

VIII

RX portable

1

1

0

AGA 24 hours

SI

discontinuous

NO

IX

INDICES OF AVAILABILITY OF RESOURCES FOR RESPIRATORY ASSÍSTANCE. Lima 2006. BASELINE Hospit al Code

Births per year

1 (*)

7303

2

7262

3

6142

4

6835

5 (**)

9377

6

6921

7

Health Network

9816

8

Health Network

11238

9

3250

10

3216

11

4454

12

3019

13

3748

14

Referral Centre

I

II

0

15

2698

16

2189

III

IV

V

VI

VII

NA

17

(level I)

6552

NA

NA

18

(level II)

3271

NA

NA

TOTAL OF BIRTHS PER YEAR (*) (**)

97291

Refuse to continue in the Project They improve process after Project finished

NA = not applicable

VIII

IX

INDICES OF AVAILABILITY OF RESOURCES FOR RESPIRATORY ASSÍSTANCE. Lima 2011. AFTER THE PROJECT. HOSPITAL

I

II

III

IV

V

VI

VII

1 (*) 2 3 4 5 (**) 6 7

Health Network

8

Health Network

9 10 11 12 13 14

NA

Referral Centre

15 16 17

(level I)

NA

NA

18

(level II)

NA

NA

(*) (**)

Refuse to continue in the Project They improve process after Project finished.

VIII

IX

IMPROVEMENT IN AVAILABILITY OF RESOURCES FOR RESPIRATORY THERAPY AT THE END OF THE PROJECT. alarm preproject/total of neonatology services

alarm postproject/ total of neonatology services

# babies per nurse in NICU

9 /13

4 /13

# babies per nurse in Intermediate Care

15 /15

4 /15

III

# babies per air compressed point

15 /15

5 /15

IV

O2 moist, warm, stable and regulated concentration.

15 /15

3 /15

# oxygen analyser per baby in oxygen therapy

15 /15

13/15

INDICATORS

I II

V

Resource available

Hospital (1) and Networks (7 y 8) are not consider.

% improved

39

73

67

80

13

Results in knowledge and skills improvement

CHANGES IN THE KNOWLEDGE ABOUT OCULAR TOXICITY OF OXYGEN REGISTERED NURSES

100 75 50 25 0

2

10

1

5

4

14

13

3

PRE TEST

64

82

77

45

54

63

14

69

POST TEST

84

100

100

100

100

100

89

93

SOME NEONATAL SERVICES OF METROPOLITAN AREA – LIMA

IMPACT ON THE REDUCTION OF SEVERE ROP

PREVENTION OF BLINDNESS DUE TO ROP IN HOSPITAL CODE 4. THREE YEARS FOLLOW UP. 100 90 80 70 %

60 50 40 30 20 10 0

screening rate

ROP rate

ROP treatment rate

2007 (89 babies)

100

29

9

2008 (157 babies)

87,7

15,3

5,7

2009 (157 babies)

86

17

4

SUMMARY OF OPHTHALMOLOGY ACTIVITIES PerIod of time

Oct-Dic

2007

2008

2009

2010

Jan-Nov 2011

total

At-risk Prem Babies examined

50

696

1160

1223

1201 4340

Babies with ROP

14

247

314

394

234

1203

Babies treated /with laser

2

55

71

67

54

249

7.9

6

5.4

4.4

% examined who were treated

•IMPACT INDICATORS OF ROP 2007 – 2011, PERU Table Nº5

Babies at risk who are examined % (n/N)

Babies with ROP % (n)

Babies treated for ROP % (n)

NICU

Pre Workshop

Post Workshop

Pre Workshop

Post Workshop

Pre Workshop

Post Workshop

11

49% (22/45)

72% (140/295)

41% (18)

23% (45)

0

3% (5)

10

90% (39/43)

88% (39/45)

46% (20)

41% (18)

0

2% (1)

4

75% (25/33)

87% (188/216)

34% 11)

18% (37)

14% (5)

8% (16)

9

63% (15/24)

94% (104/111)

No data

23% (25)

40% (10)

7% (7)

3

No data

49% (98/203)

No data

41% (82)

No data

11% (22)

2

100% (89/89)

88% (133/157)

29% (26/89)

17% (23/133)

9% (9/109)

4% (5)

RESULTS OF ROP DETECTION AND TREATMENT PROGRAMS IN 5 NICUS: BEFORE AND AFTER WORKSHOP

THE INSTITUTO DAMOS VISION THANKS: TO THE STAFF OF THE NICU SERVICES

For their enthusiastic COLLABORATION

TO THE PERUVIAN PEDIATRIC SOCIETY

FOR YOUR PARTICIPATION IN THE DIAGNOSIS SITUATIONAL

FOR THE FINANCIATION OF TRAINING AND MONITORING. FOR THE EQUIPMENT DONATION TO THE NEONATOLOGIST SERVICES.

FOR THEIR SUPPORT IN THE ROP TREATMENT