Background
Methods
Study protocol
Search strategy
Inclusion and exclusion criteria
ROP detection criteria
Selection of studies
Quality of studies
Data extraction
Statistical analysis
Results
Search results and characteristics
Ref. | First author, Published Year | Year of study | GAa (week) | BWb (gr) | Place | Sample size | Prevalence (%) | Quality | ||
---|---|---|---|---|---|---|---|---|---|---|
All | Non-ROPc | ROP | ||||||||
[11] | Naderian Gh, 2011 | 2009 | < 34 | And ≤ 1800 | Isfahan | 100 | 71 | 29 | 29 | Moderate |
[11] | Naderian Gh(1), 2011 | 2009 | < 34 | And ≤ 1800 | Isfahan | 100 | 58 | 42 | 42 | Moderate |
Mostafa Gharebagh M, 2012 | 2008 | < 34 | – | Tabriz | 71 | 41 | 30 | High | ||
[14] | Nakhshab M, 2016 | 2014 | < 30 or < 34d | – | Sari | 146 | 122 | 24 | 16.44 | High |
[52] | Naderian G, 2009 | 2002 | 25–34 | And 600–1800 | Isfahan | 796 | 662 | 134 | 16.8 | Moderate |
[53] | Hosseini H, 2009 | 2006 | < 34 | – | Shiraz | 1024 | 1004 | 20 | 1.95 | High |
[54] | Karkhaneh R, 2005 | 2000 | ≤ 37 | And ≤ 2500 | Tehran | 185 | 162 | 23 | 12.4 | High |
[55] | Naderian G, 2010 | 2003 | – | – | Isfahan | 604 | 498 | 106 | 17.5 | High |
[56] | Mansouri M, 2007 | 2004 | ≤ 32 | And ≤ 1500 | Tehran | 147 | 103 | 44 | 29.9 | High |
[57] | Nakshab M, 2003 | 2001 | – | ≤ 2500 | Sari | 68 | 60 | 8 | 11.7 | High |
[58] | Daraie G, 2016 | 2008 | < 37 | Or < 2000 | Semnan | 270 | 267 | 3 | 1.1 | Moderate |
[59] | Fayazi A,2009 | 2005 | < 32 | Or < 1500 or 1500–2500* | Tabriz | 399 | 370 | 29 | 7.26 | Moderate |
[60] | Sadeghi K, 2008 | 2006 | < 36 | And < 2000 | Tabriz | 150 | 124 | 26 | 17.3 | Moderate |
[61] | Ebrahimiadib N, 2016 | 2011 | < 37 | Or < 3000 | Tehran | 1896 | 1326 | 570 | 30.06 | Moderate |
[62] | Ghaseminejad A, 2011 | 2006 | ≤ 36 | And ≤ 2500 | Kerman | 83 | 59 | 24 | 29 | High |
[63] | Khatami F, 2008 | 2000 | < 34 | Or < 2000 | Mashhad | 50 | 36 | 14 | 28 | Moderate |
[64] | Sabzehei MK, 2013 | 2007 | – | < 1500 | Tehran | 414 | 343 | 71 | 17.14 | Moderate |
[65] | Saeidi R, 2009 | 2005 | ≤ 32 | Or < 1500 | Mashhad | 47 | 43 | 4 | 8.5 | Moderate |
[66] | Azin Far B, 2005 | 2001 | < 29 | And < 1500 | Babol | 100 | 56 | 44 | 44 | High |
[67] | Karkhanehyousefi N, 2009 | 2009 | – | – | Babol | 100 | 61 | 39 | 39 | Moderate |
[68] | Ebrahimzadeh A, 2009 | 2003 | – | – | Tehran | 1343 | 874 | 469 | 34.9 | High |
[69] | Mirzaee SA, 2010 | 2008 | – | < 2000 | Tehran | 74 | 50 | 24 | 324 | Moderate |
[70] | Mousavi Z, 2009 | 2001 | 24–36 | And 600–2900 | Tehran | 797 | 540 | 257 | 32.24 | Moderate |
[71] | Fouladinejad M, 2009 | 2004 | ≤ 34 | – | Gorgan | 89 | 84 | 5 | 5.6 | High |
[72] | Mousavi S, 2008 | 2001 | 24–36 | And 600–2800 | Tehran | 693 | 474 | 219 | 31.6 | Moderate |
[73] | Sadeghzadeh M, 2016 | 2001 | – | 450–3000 | Zanjan | 78 | 77 | 1 | 1.2 | Moderate |
[74] | Bayat-Mokhtari M, 2010 | 2006 | – | < 1500 Or 1500–2000* | Shiraz | 199 | 115 | 84 | 42 | High |
[75] | Karkhaneh R, 2001 | 1997 | < 37 | Or < 2500 | Tehran | 150 | 141 | 9 | 6 | High |
[76] | Babaei H, 2012 | 2009 | – | ≤ 1500 | Kermanshah | 84 | 73 | 11 | 13.1 | Moderate |
[77] | Abrishami M, 2013 | 2006 | < 32 | – | Mashhad | 122 | 90 | 32 | 26.2 | High |
[78] | Riazi-Esfahani M, 2008 | 2002 | ≤ 37 | And ≤ 2500 | Tehran | 165 | 125 | 40 | 24.24 | Moderate |
[79] | Alizadeh Y, 2015 | 2005 | ≤ 36 | And ≤ 2500 | Rasht | 310 | 246 | 64 | 20.6 | High |
[80] | Mousavi SZ, 2010 | 2003 | – | – | Tehran | 605 | 415 | 190 | 31.4 | Moderate |
[81] | Mousavi Z, 2010 | 2003 | – | – | Tehran | 1053 | 673 | 380 | 36.1 | High |
[82] | Feghhi M, 2012 | 2006 | < 32 | And ≤ 2000 | Ahvaz | 576 | 393 | 183 | 32 | High |
[83] | Afarid M, 2012 | 2006 | ≤ 32 | And ≤ 2000 | Shiraz | 787 | 494 | 293 | 37.2 | Moderate |
[84] | Ahmadpourkacho M, 2014 | 2009 | < 28 | And < 1500 or 1500–2000* | Babol | 256 | 76 | 180 | 70.31 | High |
[85] | AhmadpourKacho M, 2014 | 2007 | < 34 | And < 2000 | Babol | 155 | 85 | 70 | 45.2 | Moderate |
[86] | Rasoulinejad SA, 2016 | 2007 | < 36 | And < 2500 | Babol | 680 | 374 | 306 | 45 | High |
[87] | Karkhaneh R, 2008 | 2003 | < 37 | – | Tehran | 953 | 624 | 329 | 34.5 | High |
[88] | Khalesi N, 2015 | 2013 | – | – | Tehran | 120 | 60 | 60 | Moderate | |
[89] | Ebrahim M, 2010 | 2004 | < 37 | – | Babol | 173 | 140 | 33 | 19.1 | High |
[90] | Roohipoor R, 2016 | 2012 | ≤ 37 | And ≤ 3000 | Tehran | 1932 | 1362 | 570 | 3 | High |
[91] | Mansouri M, 2016 | 2013 | < 34 | Or < 2000 | Sanandaj | 47 | 42 | 5 | 10.6 | High |
Prevalence
Sensitivity analysis and cumulative analysis for ROP
Subgroup analysis of ROP prevalence based on geographic region
Variable | Studies (Na) | Sample (N) | Heterogeneity | 95% CIb | Prevalence (%) | ||
---|---|---|---|---|---|---|---|
I2 | P-Value | ||||||
Region | Center | 20 | 12,355 | 93.65 | < 0.001 | 21.8 to 28.4 | 24.9 |
East | 4 | 302 | 57.79 | 0.07 | 17 to 33 | 24.1 | |
North | 12 | 2626 | 97.09 | < 0.001 | 15.9 to 37.1 | 25 | |
South | 4 | 2586 | 98.60 | < 0.001 | 9.2 to 37.1 | 20.5 | |
West | 2 | 131 | 0 | 0.67 | 7.6 to 19.1 | 12.3 | |
Test for subgroup differences: Q = 9.67, df(Q) = 4, P = 0.046 | |||||||
Gender | Boys | 11 | 1467 | 92.65 | < 0.001 | 11.9 to 28.5 | 18.9 |
Girls | 11 | 1184 | 85.02 | < 0.001 | 12.8 to 25.4 | 18.3 | |
Rate ratio of boys to girls: ORc = 1.07(0.86 to 1.33, P = 0.501) | |||||||
Provinces | Khozestan | 1 | 576 | 0 | – | 28.3 to 35.9 | 32 |
Mazandaran | 8 | 1678 | 95.77 | < 0.001 | 23.5 to 48.2 | 34.8 | |
Isfahan | 4 | 1600 | 92.48 | < 0.001 | 16.5 to 35 | 24.6 | |
Golestan | 1 | 89 | 0 | – | 2.3 to 12.8 | 5.6 | |
Kerman | 1 | 83 | 0 | – | 20.3 to 39.6 | 29 | |
Kermanshah | 3 | 84 | 0 | – | 7.4 to 22.1 | 13.1 | |
Razavi Khorasan | 3 | 219 | 67.89 | 0.044 | 12.4 to 34.2 | 21.3 | |
Guilan | 1 | 310 | 0 | – | 16.5 to 25.5 | 20.9 | |
Kurdistan | 1 | 47 | 0 | – | 4.5 to 23.1 | 10.6 | |
Semnan | 1 | 270 | 0 | – | 0.4 to 3.4 | 1.1 | |
Fars | 3 | 2010 | 99.09 | < 0.001 | 4 to 50.8 | 17.2 | |
East Azarbaijan | 2 | 549 | 91.32 | 0.001 | 4.6 to 25 | 11.3 | |
Tehran | 14 | 10,407 | 91.32 | < 0.001 | 25.1 to 31 | 28 | |
Zanjan | 1 | 78 | 0 | – | 0.2 to 8.5 | 1.2 | |
Test for subgroup differences: Q = 97.59, df(Q) = 13, P < 0.001 | |||||||
Quality | Medium | 20 | 7760 | 63.68 | < 0.001 | 16.6 to 28.0 | 23.5 |
High | 22 | 10,240 | 96.65 | < 0.001 | 19.1 to 28.7 | 23.5 | |
Test for subgroup differences: Q = 0, df(Q) = 1, P = 0.995 |
Subgroup analysis of ROP prevalence based on province
Subgroup analysis of ROP prevalence based on the quality of studies
The prevalence of ROP based on gender
The prevalence of ROP based on stage
Meta-regression
Publication bias
ROP risk factors
Variables | Studies(Na) | Sample (N) | Heterogeneity | OR (95%CIb) | P-Value | Model in Meta-analysis | ||
Case | Control | I2 | P-Value | |||||
Twin birth | 4 | 804 | 1868 | 46.97 | 0.129 | 1.62 (0.94 to 2.81) | 0.081 | Randomc |
Mechanical ventilation | 6 | 1131 | 2493 | 73.35 | 0.002 | 1.81 (0.80 to 1.73) | 0.39 | Random |
Continuous positive pressure ventilation | 2 | 62 | 131 | 64.11 | 0.095 | 3.97 (1.21 to 13.01) | 0.023 | Random |
Blood transfusion (N) | 16 | 1820 | 4167 | 91.34 | < 0.001 | 2.38 (1.43 to 3.94) | 0.001 | Random |
Septicemia | 11 | 1327 | 2965 | 80.75 | < 0.001 | 1.96 (1.10 to 3.48) | 0.021 | Random |
Birth weight < 1000 g | 9 | 573 | 2093 | 59.65 | 0.011 | 4.16 (2.35 to 7.35) | < 0.001 | Random |
Birth weight < 1500 g | 10 | 559 | 1984 | 43.34 | 0.069 | 3.74 (2.54 to 5.49) | < 0.001 | Random |
Phototherapy (N) | 11 | 1380 | 3355 | 80.69 | < 0.001 | 1.50 (1.00 to 2.27) | 0.049 | Random |
Oxygen therapy (N) | 14 | 726 | 3124 | 87.39 | < 0.001 | 3.06 (1.29 to 7.27) | 0.011 | Random |
Need for resuscitation | 2 | 56 | 212 | 86.50 | 0.006 | 5.01 (0.18 to 135.71) | 0.338 | Random |
Apnea | 3 | 114 | 492 | 72.08 | 0.028 | 4.41 (1.70 to 11.40) | 0.002 | Random |
Congenital heart disease | 2 | 50 | 246 | 67.29 | 0.08 | 2.13 (0.10 to 45.62) | 0.626 | Random |
Inter-ventricular hemorrhage | 11 | 1223 | 3178 | 76.36 | < 0.001 | 2.24 (1.2 to 3.95) | 0.005 | Random |
Acidosis | 3 | 132 | 296 | 62.62 | 0.069 | 2.56 (0.81 to 8.06) | 0.106 | Random |
Cesarean section | 4 | 375 | 830 | 47.88 | 0.124 | 1.08 (0.53 to 2.18) | 0.82 | Random |
Preeclampsia | 2 | 108 | 237 | 0 | 0.82 | 0.12 (0.02 to 0.65) | 0.014 | Fixedd |
Respiratory distress syndrome | 11 | 2039 | 2618 | 80.13 | < 0.001 | 1.64 (1.03 to 2.61) | 0.036 | Random |
Saturation above 50% | 4 | 118 | 656 | 30.30 | 0.23 | 8.35 (3.14 to 22.18) | < 0.001 | Random |
Normal Vaginal Delivery | 4 | 375 | 830 | 46.63 | 0.132 | 1.01 (0.50 to 2.02) | 0.969 | Random |
Multiple pregnancy | 6 | 1199 | 2518 | 40.20 | 0.137 | 0.92 (0.73 to 1.16) | 0.517 | Random |
Gestational age ≤ 28 | 6 | 551 | 1440 | 75.88 | < 0.001 | 5.20 (2.31 to 11.73) | < 0.001 | Random |
Gestational age ≤ 32 | 9 | 689 | 1885 | 64.84 | 0.004 | 7.88 (4.62 to 13.46) | < 0.001 | Random |
Birth weight (gr) | 7 | 1495 | 2893 | 97.30 | < 0.001 | 0.98 (0.97 to 0.99) | < 0.001 | Random |
Gestational age (week) | 7 | 1495 | 2893 | 84.20 | < 0.001 | 0.67 (0.59 to 0.770) | < 0.001 | Random |
Variables | Studies(Na) | Sample (N) | Heterogeneity | Mean Difference (95% CIb) | P-Value | |||
Case | Control | I2 | P-Value | |||||
Gestational age (weeks) | 18 | 1835 | 4126 | 94.53 | < 0.001 | 2.08(1.50 to 2.66) | < 0.001 | Random |
Birth weight (gr) | 19 | 1782 | 4519 | 95.94 | < 0.001 | 305.39(236.09 to 374.69) | < 0.001 | Random |
Oxygen therapy (day) | 11 | 1399 | 3214 | 96.04 | < 0.001 | −4.36(−6.09 to −2.63) | < 0.001 | Random |
Phototherapy (days) | 4 | 78 | 308 | 83.80 | < 0.001 | −2.08(−3.81 to −0.35) | < 0.001 | Random |
Apgar score in the first minute | 3 | 174 | 216 | 63.30 | 0.66 | 1.07(0.45 to 1.68) | 0.001 | Random |
Apgar score | 3 | 64 | 272 | 76.34 | 0.015 | 0.43(−0.25 to −1.13) | 0.21 | Random |
Mechanical ventilation (days) | 2 | 114 | 154 | 88.81 | 0.003 | −4.53(−9.17 to 0.10) | 0.55 | Random |
Bilirubin (mg/di) | 3 | 54 | 186 | 7.70 | 0.33 | −0.27(−1.40 to 0.86) | 0.63 | Random |
Blood transfusion (duration) | 2 | 98 | 151 | 0 | 0.98 | −0.69(−0.96 to − 0.42) | < 0.001 | Fixed |
clinical risk index for babies | 2 | 161 | 250 | 58.84 | 0.11 | −0.62(− 1.40 to 0.16) | 0.11 | Random |
Discussion
Study details | GA (weeks) | BW (gr) | Risk factors |
---|---|---|---|
Reyes et al., 2017. Oman [46] | < 32 | < 1500 | low BW, low GA, duration of invasive ventilation, duration of oxygen therapy, duration of nasal CPAP, late onset clinical or proven sepsis |
Shah et al., 2005 Singapore [40] | < 32 | < 1500 | Preeclampsia, low BW, prolonged duration of ventilation, pulmonary hemorrhage and CPAP |
Yau et al., 2016, China [45] | < 32 and > 32 | < 1500 | low GA, low BW, preeclampsia, gestational diabetes mellitus, inotrope use, postnatal hypotension, apgar score (1 min, 5 min and 10 min), respiratory distress syndrome, bronchopulmonary dysplasia, invasive mechanical ventilation, surfactant use, oxygen supplement, patent ductus arteriosus, thrombocytopenia, blood transfusion, anemia, NSAID use, sepsis |
Abdel HA et al., 2012, Egypt [34] | < 32 and > 32 | < 1500 and > 1500 | low GA, oxygen therapy, frequency of blood transfusions and sepsis |
Chen et al., 2011, USA [41] | < 30 | < 1500 | low GA, Sepsis, oxygen exposure |
Hadi and Hamdy, 2013, Egypt [37] | < 32 | < 1250 | low GA, low BW, Ventilation, blood transfusions, sepsis, Patent ductus arteriosus, IVH |
Nair et al., 2001, Oman [36] | < 32 | < 1500 | low BW, Low GA, TPN |