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World Prematurity Day: Do not just think about survival for newborns, but also their visual health


The World Health Organization (WHO) celebrates the world's prematurity day every year on November 17 to focus on premature children.

Retinopathy of prematurity (ROP) is a dynamic, time-related disease that is not present at birth. The condition is associated with the eyesight of children who have previously received intensive newborn care (with or without oxygen treatment) that help save their lives but seriously affect their eye development.

The condition is characterized by the development of abnormal blood vessels in the esophagus, resulting in scarring and retinal removal. ROP can be mild and can resolve spontaneously, but in serious cases it can progress and lead to blindness.

ROP usually starts only two to three weeks after birth, which provides a window for screening and activation of treatment at the right time, while the child is still undergoing neonatal care at the hospital.

However, ROP can be treated by lasers if it is detected by proper retinal examination before 30 days after birth. "Tees Din Roshni Ke" (thirty days for Vision) should be a slogan implemented for all early children. Inability to get the first retinal screening done efficiently and on time is a big gap that needs to be addressed. Lack of trained staff to deliver effective treatment at the bed for infants, especially those who are still in critical care, and then the difficulties with a follow-up are some of the gaps that need to be addressed.

Chronic hypoxia (lack of oxygen), intrauterine growth retardation and prenatal and postnatal conditions are the most common triggers of ROP. Children born for 34 weeks gestation and weighing less than 2000 grams are especially susceptible to ROP and must be screened within 20-30 days of birth.

High levels of additional oxygen and high carbon levels are also known to aggravate ROP. During neonatal incubation, premature babies should be mixed with oxygen, strictly controlled and monitored by pulse oximeters. Other risk factors associated with the condition include anemia, bradycardia (low heart rate), blood transfusions and intraventricular haemorrhage (hemorrhage).

The initial pre-term incubators were established in Boston in 1941 and the first ROP blind child was immediately reported in medical journals in 1942. Since then, there has been a great deal of research and understanding of risk factors and successful management of this condition. Today, we have extensive knowledge to prevent ROP blindness and have successfully done it for more than 90 percent of the children. While many children are now being screened for ROP on time and treated in many large and smaller cities in India, there are huge gaps and therefore there are still many ROP blind and visually affected premature children today.

A very tight safety net has to be introduced because the early baby retains the potentially good vision they are born with. Holes in this aspect can result in irreversible damage and a lifetime for poor vision.

Common gaps include the absence of information about ROP among various cadres of healthcare professionals and parents during the first critical days; The medical curriculum for only a few super specialists including ROP; and lack of trained staff to deliver effective treatment for children who are still in critical care, among others.

All pre-term children run a higher risk of developing other eye and vision related complications later in life. Common disorders include retinal detachment, myopia (myopia), strabismus (crossed eyes), amblyopia (lazy eye) and glaucoma.

ROP is a potentially avoidable cause of irreversible and usually total blindness in children prematurely. This disease has lifelong consequences for affected children and their families. Survival is achieved because of the great efforts of parents, the extended family, doctors, nurses and health policy makers, in addition to technical progress and after the well-worked processes under the critical care of the newborn baby.

WHO has highlighted ROP as an important target disease in its prevention of blindness programs, "Vision 2020: Right to Sight", to combat global unpleasant blindness by 2020. On this world's prematurity day, everyone involved should not only think of "born survival" but also their "vision".

(Dr. Subhadra Jalali, Director, Newborn Eye Health Alliance, L.V. Prasad Eye Institute Network, Hyderabad. The expressed views are personal.)

First Published: November 17, 2018 2:00 PM IST

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