Do not just think about the survival of newborns, but also about their sight

By Dr. Subhadra Jalali, November 17: The World Health Organization (WHO) celebrates World Preterm Birthday on November 17 each year to highlight premature babies.

Retinopathy of prematurity (ROP) is a dynamic, time-related disease that is not present at birth. The disease affects the eyes of premature babies who have generally received intensive neonatal care (with or without oxygen therapy), which helps them to save their lives, but seriously affects the development of their eyes.

The disease is characterized by the development of abnormal blood vessels in the retina of the eye, resulting in scarring and detachment of the retina. The POR may be mild and may resolve itself spontaneously, but in severe cases it may progress rapidly and lead to blindness.

The POR usually only starts two to three weeks after birth, which makes it possible to screen and activate the treatment at the right time, while the baby is still under neonatal care at the hospital.

ROP can, however, be laser treated if it is detected by appropriate retinal examination before 30 days after birth. "Tees Din Roshni Ke" (Thirty days for Vision) should become a slogan applied to all premature babies. The inability to do the first retinal screening effectively and on time is a huge gap that needs to be filled. The shortage of qualified personnel to provide effective bedside treatment for infants, particularly those still in critical care, and the ensuing difficulties with 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. Babies born less than 34 weeks gestation and weighing less than 2,000 grams are particularly susceptible to the disease and should be examined within 20 to 30 days of birth.

It is also known that high levels of oxygen and carbon dioxide aggravate ROP. During the neonatal incubation, premature babies should receive mixed oxygen, strictly controlled and monitored with the help of a pulse oximeter. Anemia, bradycardia (low heart rate), blood transfusions and intraventricular hemorrhages (bleeding in the brain) are other risk factors associated with the disease.

The first incubators for prenatal consultations were set up in Boston in 1941 and the first ROP blind baby was promptly reported in medical journals in 1942. Since then, extensive research and understanding of risk factors and successful management of this state. Today, we have extensive knowledge of POR blindness prevention and we have been able to do this for more than 90% of babies. While many babies are currently being tested for TBP on time and are being treated in many large and small Indian cities, there are significant gaps, so there are still many premature blind babies with ROPs today.

A very narrow safety net must be put in place so that the premature baby can maintain the potentially good vision with which he was born. Gaps in this aspect can lead to irreversible damage and a life of poor vision.

Common gaps include the lack of ROP information among the various cadres of health workers and parents during the first critical days; the medical program of some super-specialists, including ROP; and the shortage of qualified personnel to provide effective treatment to babies still under critical care, among others.

All premature children are at a higher risk of developing other ocular and visual complications later in life. Common conditions include retinal detachment, myopia (myopia), strabismus (crossed eyes), amblyopia (lazy eye) and glaucoma.

POR is a potentially preventable cause of irreversible and generally total blindness in premature babies. This disease has lifelong consequences for affected children and their families. Survival is achieved through the tremendous efforts of parents, extended family, physicians, nurses, and health officials, as well as advances in technology and adherence to well-defined processes in critical care provided to newcomers. born.

The WHO has highlighted lung disease as the main target of its blindness prevention program, "Vision 2020: Right to Sight", to fight global blindness by 2020. On World AIDS Day prematurity, all those involved should not only think of the "new survival" but also their "vision".

(Dr. Subhadra Jalali, Director of the Alliance for Eye Health of Newborns, L.V. Prasad Eye Institute Network, Hyderabad, The views expressed are personal and can be contacted at [email protected])