Delayed Screening and Advanced-Stage Retinopathy of Prematurity at an Indonesian Tertiary Referral Hospital: A Cross-Sectional Study

Abstract

Background: Retinopathy of prematurity (ROP) is a leading preventable cause of childhood blindness, with its burden shifting toward middle-income countries where neonatal survival outpaces screening capacity. Indonesian data on programme performance are scarce.

Objective: To describe the screened population, quantify screening timeliness, and compare the observed ROP burden with Indonesian gestational-age-specific reference rates.

Methods: A cross-sectional study at M. Djamil General Hospital, Padang, ran from January to December 2025. Total sampling enrolled 278 preterm infants undergoing initial screening; 277 had complete funduscopic data, classified by ICROP3. Proportions carry Wilson 95% confidence intervals (CI). Indirect standardisation against Indonesian gestational-age-stratum rates gave a standardised morbidity ratio (SMR); as the records hold only marginal distributions, multivariable parameters were bounded by partial identification.

Result: Infants were mostly male (161/277; 58.1%, 95% CI 52.2–63.8) and born at 28–32 weeks (53.1%); 98.9% weighed 1500–2500 g, 75.5% had oxygen beyond 7 days. ROP was detected in 31/277 infants (11.2%, 95% CI 8.0–15.4). No infant had stage 1 disease, whereas 22/31 (71.0%) had stage 3 or worse and 12/31 (38.7%) stage 4–5. Observed cases exceeded the 19.2 expected (SMR 1.61, 95% CI 1.10–2.29; p = 0.016), but excluding stage 4–5 returned the ratio to unity (0.99, 0.60–1.54). Two-factor standardisation held it at 1.48–1.85 across every admissible oxygen distribution. First examination occurred beyond 8 weeks chronological age in 42.4%.

Conclusion: ROP prevalence was well below pooled global estimates, yet the cohort carried an excess of advanced disease that adjustment for oxygen and birth weight does not explain, and none of the early disease a timely programme detects. This indicates delayed detection, not low risk; timeliness is the priority.