Keeping an eye on the preemie’s eye

While in the womb, the foetus is nourished by the mother’s blood which also helps in developing every tissue, organ and limb

November 26, 2014 10:49 pm | Updated 10:49 pm IST

Normal retinal blood vessels’ growth is incomplete in a premature baby. Photo: K. Gopinathan

Normal retinal blood vessels’ growth is incomplete in a premature baby. Photo: K. Gopinathan

Every new born baby is a source of joy, but also one that needs tender loving care. Every day in India, over 10,000 babies are born. While most of them are born full-term, which is after 38-40 weeks of pregnancy, one in ten of them is born premature. These pre-term babies, born before 37 weeks, are termed premature, or fondly called Preemies. Those born before 35-37 are mildly premature, before 32 weeks termed moderately premature and those born before 28 weeks are extremely premature. Each of these needs special care at least for a month (or more) after birth in order to bring them to normal health.

While growing in the mother’s womb, the baby-to-be is nourished by the mother’s blood which also helps in developing every tissue, organ and limb. This requires the full term. In preemies, this development is halted upon birth, and thus the baby needs external help to come to completion. This external development is helped by placing the preemie in hospital incubators. Such an incubator keeps the baby warm, removes excess bile pigments which colour the skin of the baby somewhat yellowish by shining cool blue fluorescent lamps, and where necessary provides oxygen, including through continuous positive airway pressure.

A particularly important organ that needs attention is the eye of all these preemies. In the baby-to-be in the womb, the eye starts to develop at 16 weeks of pregnancy. Blood vessels of the retina (or the screen in the back of the eye, where the external image is collected and the information relayed to the brain through the optic nerve) start forming. They supply oxygen and nutrients to the eye. During the next 12 weeks, the eye develops rapidly until the baby reaches full term. It is mostly complete at 4-6 weeks past birth.

In a preemie, this normal vessels growth is incomplete; the edges of the retina are starved of nutrients and oxygen. As a result, abnormal and twisted blood vessels starts forming, generating a fragile retinal screen which becomes scarred, leading to the pulling of the retina out of the position, creating what is termed as retinal detachment within a few weeks of birth. This disorder of the eye in a newborn preemie is termed Retinopathy of Prematurity or ROP, a major threat to vision in the baby. Given the thousands of preemies born daily in India, ROP has grown to epidemic proportions. My colleague Dr Subhadra Jalali estimates that the prevalence of ROP in India could be about 20-40 per ncent already and that by the year 2020, as many as 50,000 school-entry children will be impacted in India.

Happily enough, ROP can be treated or managed if discovered early enough, between 20-30 days after birth. These 30 days are called Tees Din Roshni Ke (or thirty days to brightness). Highly efficacious, scientifically proven and accessible technology has become available to manage ROP during the last 20 years. Various multiple-centre prospective studies have conclusively proven that timely detection and treatment can markedly reduce blindness due to ROP. It is estimated that more that 60 per cent of visual impairment in babies is preventable or curable with timely detection and prompt and appropriate management.

Happily enough again, such an effort has been going on for the past 15 years in India through partnership between eye doctors with ROP expertise on one hand and neonatologists in paediatric clinics on the other. For example, with support from various NGOs, individuals and also the state government of Andhra Pradesh (including Telangana), through the National Rural Health Mission, under what is referred to as ITCROPS (Indian Twin Cities Retinopathy of Prematurity Screening), it has been possible to offer management including surgical care to well over 10,000 preemies.

This has now become part of a national level programme, supported by the Union Health Ministry. ROP experts across the country are working hand-in-hand with neonatologists. Given that 50,000 school-entry children will be impacted in India with ROP, such a national level initiative is a welcome move. At a professional ROP meeting held two weeks ago, world experts in ROP such as Dr Lingam Gopal of Singapore (who pioneered ROP in India, while at Sankara Nethralaya, Chennai) and Dr Michael Trese of Michigan (an acknowledged leader in the field) appreciated this remarkable move in India, and have offered their full support to this programme.

Most hospitals, government or private, have now routinely equipped their paediatric and neonatal wards with incubators and associated devices. But many of them are yet to train their neonatologists on the need for screening for ROP. “The incubator companies just install the machines in paediatric clinics and go away. If only they take time out to transfer the knowledge and the science that comes along with such equipment transfers, teach these care-givers the procedures and the do’s and don’ts, the detection and management of ROP cases can be vastly increased and improved. If only…” laments Dr. Subhadra Jalali, the Preemie-Premi. I hope they are reading this and will oblige.

dbala@lvpei.org

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