World Prematurity Day: Don't just think about the survival of a newborn, but also their vision health



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The World Health Organization (WHO) celebrates World Prematurity Day every year on November 17, to highlight premature babies.

Retinopathy of Prematurity (ROP) is a dynamic, time-bound disease that is not present at birth. This condition affects the eyes of premature babies who specifically receive intensive neonatal care (with or without oxygen therapy) that helps save their lives, but greatly affects the development of their eyes.

This condition is characterized by the development of abnormal blood vessels in the retina of the eye, which results in scarring and retinal detachment. ROP can be mild and can disappear spontaneously, but in serious cases, it can develop quickly and cause blindness.

ROP usually starts only two-three weeks after birth, provides a window for treatment and activation at the right time, while the baby is still in neonatal care at the hospital.

However, ROP can be treated with laser if detected by retinal examination just before 30 days of birth. "Tees Din Roshni Ke" (Thirty days for Vision) must be the slogan implemented for all premature babies. The inability to get the first retinal screening done effectively and on time is a big gap that needs to be addressed. Lack of personnel trained to provide effective treatment at the bedside for babies, especially those who are still in critical care, and then the difficulties of follow-up are some gaps that need to be addressed.

Chronic hypoxia (lack of oxygen), intrauterine growth retardation and prenatal and postnatal conditions are the most common ROP triggers. Babies born under 34 weeks of pregnancy and weighing less than 2,000 grams are very susceptible to ROP and should be screened within 20-30 days of birth.

High supplemental oxygen levels and high levels of carbon dioxide are also known to worsen ROP. During neonatal incubation, premature infants must be given mixed oxygen, tightly controlled and monitored using pulse oximeters. Other risk factors associated with the condition include anemia, bradycardia (low heart rate), blood transfusion and intraventricular bleeding (bleeding into the brain).

Early incubators for pre-requisites were established in Boston in 1941 and the first ROP blind baby was immediately reported in a medical journal in 1942. Since then there has been a large amount of research and understanding of risk factors and the success of this management. condition. Today we have extensive knowledge to prevent ROP blindness and have succeeded in doing it for more than 90 percent of babies. While many babies are now screened for ROP on time and treated in many large and small cities in India, there are substantial gaps and hence there are still many premature babies affected by ROP and are blind at this time.

Very tight safety nets must be prepared for premature babies to maintain a vision that has the potential to be born. Gaps in this aspect can result in permanent damage and a period of poor vision.

Common gaps include the absence of information about ROP among various cadres of health workers and parents during the initial critical days; the medical curriculum is only a few super specialists including ROP; and lack of trained personnel to provide effective care for infants who are still in critical care, among others.

All pre-term children run a higher risk of developing other eyes and complications related to vision later in their lives. General misery includes retinal detachment, myopia (farsightedness), strabismus (crossed eyes), amblyopia (lazy eye) and glaucoma.

ROP is a potential cause to avoid irreversible blindness and is usually total in premature infants. This disease has lifelong implications for children who are attacked and their families. Survival is achieved due to the great team effort by parents, extended families, doctors, nurses and health policy makers, in addition to technological advances and following well-organized processes during the critical care of newborns.

WHO has highlighted ROP as the main target disease in the prevention of blindness programs, "Vision 2020: Right to Vision", to combat unnecessary blindness globally by 2020. In this Premature World Day, everyone involved must think not only about " new-born alive "but also their" vision ".

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

First Published: 17 Nov 2018 14:00 IST

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