Dr. Subhadra Jalali (Consultant Ophthalmologist at LV Prasad Eye Institute) & Dr. Tejo Pratap Oleti (Head - Neonatology unit, Fernandez Hospital) spoke to PatientsEngage on the issue of premature blindness in newborns, specifically due to Retinopathy of Prematurity. "30 Din Roshni ke"
17th November is observed as World Prematurity Day every year to raise awareness of preterm birth and address the concerns of preterm babies. Around 3 million premature babies are born preterm each year in India. India has the largest number of blind babies in the world with the most common causative factors as Retinopathy of Prematurity, congenital cataract, congenital glaucoma and cerebral visual impairment.This article based on the webinar discussion with Dr. Subhadra Jalali (Consultant Ophthalmologist at L V Prasad Eye Insitute) & Dr. Tejo Pratap Oleti (Head – Neonatology unit, Fernandez Hospital) helps us understand about Retinopathy of prematurity in preterm babies. Timely screening, early detection and treatment of ROP in all the premature babies are crucial in preventing blindness.
What is ROP and premature blindness?
ROP, Retinopathy of Prematurity is a blindness occurs exclusively in premature babies and mostly in babies who are saved through hospital systems. Retinopathy of Prematurity (ROP) was previously known as Retrolental Fibroplasia. Whereas premature babies or preterm babies who are born before nine months, delivered before 37 weeks and weigh less than 2kg (criteria varies in different countries) are at higher risk of developing premature blindness as their retina is not developed fully. Normally, retina is fully developed at 40 weeks.
How to prevent ROP?
Prevention of premature birth can prevent development of ROP. Hence minimization of the factors contributing to preterm birth or premature birth is crucial for ROP prevention.
- Quality antenatal care and post-natal care
- Pre conception and pre pregnancy counselling
- Proper referral of mother during pregnancy. i.e., based on need at Primary, Secondary and Tertiary level health care center
- Antenatal corticosteroids and cervical length screening for premature birth
- Timely screening and care of vulnerable new born babies. i.e., babies born with assisted fertilization, IVF babies, surrogacy babies or low birth weight babies
- Managing chronic illnesses during pregnancy like Gestational diabetes, pregnancy induced hypertension etc.
- Avoid teenage pregnancies and multiple pregnancies
- Anemia control and proper maternal nutrition during pregnancy.
- No Alcohol, smoking, and drug abuse during pregnancy
Steps to be taken immediately after birth to prevent ROP
- Delay cord clamping for initial stabilization of baby
- In case of immature lungs, breathing support to new born through C-PAP or non-invasive ventilation techniques
- Oxygen support through blenders if required.
- Oxygen is main culprit for ROP. Hence managing it is very crucial part.
- Oxygen saturation in new born should be between 91% to 95%.
- Using mother’s milk or donor’s milk to avoid growth failure in baby
- Eye screening by Ophthalmologist
- Restriction of unnecessary blood transfusion
- Maintaining aseptic environment by clinical care team and visitors
- Family centric approach
What are the symptoms of ROP?
Early signs of eye abnormalities include shaking or lack of proper eye movement, white color reflection, and unusual hand movements near the eyes by babies. Immediate eye check-up is required if any of these early signs are noticed.
When to visit an Ophthalmologist?
Ideally, an Ophthalmologist should be visited within 20 to 30 days of birth and no delay is accepted in that. If baby is admitted in NICU, Pediatrician should recommend eye screening of baby by an Ophthalmologist. Periodic eye screening of all premature and low birth weight babies is necessary to prevent blindness in later stages of life.
What are the treatment protocols for ROP?
Treatment and management options depend on the stage of ROP. Stage 4 ROP can be helped with glasses, magnifiers, or low vision aids, while stage 5 ROP may require rehabilitation and specialized education. Although vision loss may still occur for some children. Comprehensive support and interventions, including braille education, can enable them to reach their full potential. It is important for parents to accept the situation, seek rehabilitation programmes, and understand that many blind children can thrive and enjoy lives fully.
There are two types of retinopathy of prematurity: Mild and severe.
Aggressive ROP requires immediate treatment within 24 to 48 hours as it progresses quickly. Mild ROP requires further checkups and can be treated with medical intervention to prevent progression. Babies with ROP are monitored every two weeks, and around 60-70% of cases resolve in four to six weeks. Injections in the eye are administered in aggressive cases. Further checkup is required for a year in these babies. In case of mild ROP laser treatment is given. Emergency surgery may be required in rare cases too. Full family support for better mental health of mother. Close collaboration between parents, doctors, and the hospital is crucial for the baby's well-being
What will be the recommendations to policy makers for ROP prevention?
There are some gaps to be filled to strengthen implementation of existing health programmes. Improving retinopathy of prematurity (ROP) screening under RBSK with Public Private Partnership. The coverage for ROP screenings is around 30-40%, particularly in rural areas. It is important to establish public-private partnerships and ensure the availability of screening programs in hospitals and NICUs.Regular training of Ophthalmologists in ROP screening and concern guidelines. Training of all Medical officers, Field staff like CHO, ANM, MPHW, ASHA on basic ROP screening. Eye screening should be compulsory at every level. i.e., Primary care, Secondary care or tertiary care level. Setting up proper screening system and improving accessibility to eye care through public private partnership for saving babies from blindness. Implementation and incorporation of ROP screening guidelines in every state
- Timely treatment of baby under RBSK to avoid severe complications.
- Promotion of pre conception counselling.
- Quality antenatal and post-natal care of mother.
- Spread awareness about importance of fetal autopsy and placental biopsy in public health institution. It can determine cause of death of premature baby and helpful to avoid further risk in next pregnancy. Banners or clips in local language can be helpful for people to understand the importance.
- Timely referral based on severity and complexity of case to avoid further delay.
- Use of telemedicine and cameras in rural set up or to avoid multiple hospital visits.
- Spread awareness about free treatments or health insurance schemes implemented by Government.
- Encourage timely eye screening, hearing screening and hypothyroid screening for better development of baby.
- Advocacy for ROP through community influencers, actors, PRIs or social activists.
- Inclusion of ROP in curriculum of MBBS students, nurses, ANM and school students like vaccination.
There is a belief if I take bed rest I will not get premature birth – is this true?
It is a myth. Maternal nutrition, anemia control and balanced diet plays a very important role in normal birth of baby. Periodic health monitoring, pre pregnancy and pre conception counselling is crucial. All these will influence the overall health of mother and baby.
Does ROP run in families?
ROP doesn’t run in families as it is not an ancient disease. It is a medical issue which needs timely neonatal care for prevention. It has very less influence on genetics.
Message from Dr. Tejo Pratap Oleti - “we should not be fearing about prematurity. Being premature is not a curse for the baby, but providing best care during both the perinatal period and the postnatal period is crucial. From parental aspect, interaction with baby and the positive touch can positively affect baby’s brain and retina development.”
Message from Dr. Subhadra Jalali - “I want our PM and celebrities to say to talk about ‘30 din Roshni ke’. I want people to go out and shout loud on World Prematurity Day – 17th November, I want to see that every parent knows about eye care in our country like 2 drops of Polio”.
