On World Prematurity Day, Professor Clare Gilbert, Co-director ICEH on why ROP needs to be an integral component of neonatal care .
Preterm birth is an important cause of visual loss in children in all regions: in high income settings it is the commonest cause of cerebral visual impairment, and in many middle income countries retinopathy of prematurity (ROP) is the leading cause of avoidable blindness in children. Recent estimates suggest that 32,300 preterm babies become blind or visually impaired from ROP every year. All regions are affected, with the greatest numbers being in East and South East Asia and the Pacific regions. The most important risk factors for ROP are low gestational age and low birth weight, exposure to too much oxygen, infection and failure to gain weight after birth.
Strategies to reduce visual loss from ROP include preventing preterm birth; high quality neonatal care from immediately after birth; screening from a few weeks after birth to detect infants who develop the sight-threatening stages of ROP, followed by urgent laser treatment of the peripheral retina. Long-term follow up is also required, as children born preterm have a greater risk of refractive errors and strabismus, and may have cerebral visual impairment.
Preventing preterm birth is challenging as the underlying cause is often not known, but a course of antenatal steroids given to mothers before they deliver preterm reduces the risk of many complications, including ROP. High quality neonatal care entails gentle resuscitation after birth, and careful administration of oxygen with continuous monitoring of blood oxygen levels. Infection can be reduced by handwashing and other measures, and feeding preterm babies human breast milk and using kangaroo care promote growth and reduce the risk of ROP. A team approach, which involves parents, is critical.
Many low income countries are expanding services for preterm babies, including in Africa, and so the number who survive and are at risk of ROP is increasing. Many countries now have programmes for screening and treating ROP, but coverage needs to improve to ensure that no preterm babies at risk of blindness from ROP are missed.
It is unfortunate that although ROP was recognised as an important cause of blindness in children in middle income countries 20 years ago1, that policies and programmes for ROP were not included as an integral component of neonatal care as these services were developed.
However, control of visual loss from ROP is a priority in global eye care policies, and several IAPB members are supporting activities to initiate or strengthen capacities for ROP in countries across Latin America, Eastern and Central Europe and Asia and, increasingly in Africa. It is crucial that these initiatives are embedded in child health policies and programmes, as eye care providers cannot solve the problem of ROP blindness in isolation.
- Gilbert Clare, Rahi Jugnoo, Eckstein Michael, O’Sullivan Jane and Foster Allen. Retinopathy of prematurity in middle-income countries. The Lancet 1997 350 12-14.
Photo on top: Premature baby being examined by an ophthalmologist being trained in ROP screening in a neonatal intensive care unit in Nashik, Maharashtra
Photo courtesy: Clare Gilbert
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