In some cases, babies who are born prematurely are potentially exposed to certain diseases. One of them isretinopathy of prematuritywhich can attack a child’s eyes.
Parents may not realize whether their child has it or not, because the signs rarely appear at birth. Further examination is needed to confirm this condition.
Definition of Retinopathy of Prematurity
Retinopathy of prematurity(ROP) is an eye disease that can occur in premature babies . It can cause abnormal blood vessels to grow in the retina, and can lead to blindness.
Typically, ROP affects babies born before 31 weeks of pregnancy with a birth weight of around 1,250 grams or less. In most cases, ROP can resolve on its own without special treatment and does not cause damage. However, if a child experiences advanced ROP, it can cause permanent vision problems or blindness.
In ROP, blood vessels swell and grow excessively in the light-sensitive nerve layer of the retina at the back of the eye. As the condition progresses, the abnormal retinal blood vessels extend into the jelly-like substance (vitreous) that fills the center of the eye.
Bleeding from these blood vessels can injure the retina and stress its attachment to the back of the eye. This is what causes partial or complete retinal detachment and can potentially cause a child to lose their vision.
Symptoms of Retinopathy of Prematurity
There are no specific signs that indicate a baby hasretinopathy of prematurity.However, your baby will usually have an eye exam for ROP if they have the following conditions:
- Born before 30 weeks
- Weighing less than 1.3 kg at birth
- Born after 30 weeks or weighing 1.3 to 2 kg at birth and having risk factors for ROP
Causes of Babies Being Born with ROP
As your baby’s eyes begin to develop during pregnancy, blood vessels form at the back of the eye to provide the retina with the oxygen and nutrients it needs. Your baby’s eyes develop rapidly during the last 12 weeks of pregnancy.
Then when your baby is born, most of the blood vessels in the retina are almost fully grown. However, the retina usually finishes growing within the first few weeks after birth.
If a baby is born too early, the blood vessels in the retina may stop growing or may not grow properly. They can grow abnormally from the retina to the back of the eye. These blood vessels are fragile and can leak.
This condition can cause bleeding in the eye, and scar tissue to form. If the scars shrink, they can pull the retina away from the back of the eye. This is called retinal detachment. Retinal detachment is the leading cause of vision loss and blindness in ROP.
Frequency of Occurrence
This condition is quite common in newborns, but most babies born with ROP have mild cases and do not require treatment. Quoting fromMarch of Dimes, approximately 14,000 to 16,000 babies born in the United States each year have ROP.
However, babies with severe ROP can experience vision problems and even blindness. About 400 to 600 babies each year become blind from ROP.
Risk Factors for Children Exposed to ROP
There are several things that make a baby more likely to experience ROP, these are called risk factors. However, risk factors do not mean that your baby will definitely experience it. Risk factors for ROP include:
- Anemia . This occurs when the body does not have enough healthy red blood cells to carry oxygen throughout the body.
- Birth weight . Babies born weighing less than 1.3 kg are more likely to have ROP than babies born weighing more than that.
- Breathing problems, including apnea and respiratory distress syndrome . These problems are common in premature babies because their lungs and the parts of the central nervous system (brain and spinal cord) that control breathing may not be fully developed. Apnea is when a baby’s breathing stops for 15 to 20 seconds or more. This can cause a drop in the baby’s oxygen level (oxygen desaturation) and a slow heart rate (bradycardia). Respiratory distress syndrome is a common problem in premature babies. It’s caused by a lack of surfactant, a slippery substance that keeps the tiny air sacs in a baby’s lungs from collapsing.
- Heart disease or slow heart rate . Heart disease includes conditions that affect the heart and blood vessels.
- Infection and sepsis . Sepsis is the body’s extreme response to infection. It can make a baby susceptible to ROP.
- Premature birth . All premature babies are at risk forretinopathy of prematurity. Premature babies born before 30 weeks of pregnancy are most likely to have it.
- Blood problems, including low blood oxygen, high blood carbon dioxide, low blood acidity, or blood transfusions . Your doctor will likely measure your baby’s blood oxygen, carbon dioxide, and blood acidity levels with a blood oxygen level test. If the levels in the blood are out of balance (not the right amounts), it could mean your baby’s lungs aren’t working well. Low blood oxygen, high carbon dioxide, and low blood acidity may be signs of a respiratory system disorder in your baby.
Diagnosis of ROP in Infants
Typically, ROP does not show any specific signs or symptoms when it first develops in a newborn. The only way to diagnose it is through an eye exam by an ophthalmologist.
For an eye exam, your child’s eye doctor will check your baby’s vision. He or she will identify and treat any problems with your child’s eyes.
Your baby will likely have his first eye exam 4 to 9 weeks after birth. He may be in the neonatal intensive care unit (also called the NICU ), or he may be at home by now.
Babies born at 27 weeks or later usually have their first eye exam at 4 weeks of age. Babies born before 27 weeks usually have their exams later. This is because the more premature the baby, the longer it takes for serious ROP to develop.
For that, Parents, it is important to bring your baby to every eye exam. Keep doing this routinely even after you bring your baby home from the NICU.
If the initial eye exam shows that the blood vessels in both of your baby’s retinas have developed normally, your baby will not need further testing. However, if your baby’s eye exam shows signs of ROP, your doctor may recommend treatment.
Treatment can begin within 72 hours. Early treatment gives your baby the best chance of healthy vision.
Complications That Can Occur
Citing a study from the National Library of Medicine , complications that can occur due to ROP include:
- Myopia
- Early development of cataracts
- Iris neovascularization
- Glaucoma
- Retinal pigmentation
- Retinal folds
- Retina drag
- Lattice-like degeneracy
- Retinal tear
- Rhegmatogenous and exudative retinal detachment.
Treatment of Retinopathy of Prematurity
Treatment for ROP depends on its severity. Here are some types of treatments that can be done:
Laser Therapy
The standard treatment for advanced ROP is laser therapy. This involves burning the area around the edge of the retina, which is devoid of normal blood vessels.
This procedure usually preserves vision in the main part of the visual field, but at the expense of side (peripheral) vision. This surgery requires general anesthesia, which can be risky for premature babies.
Cryotherapy
Cryotherapyusing a tool to freeze a specific part of the eye that extends beyond the edge of the retina. This method is the first treatment for ROP.
However, this is rarely used now because the results of laser therapy are generally better. Like laser therapy, this treatment damages some peripheral vision and must be performed under general anesthesia.
Treatment
Research on drugsantivascular endothelial growth factor(anti-VEGF) to treat ROP is underway. Anti-VEGF drugs work by blocking the overgrowth of blood vessels in the retina. They are given by injecting the drug into the eye while the baby is under a brief general anesthesia.
Although no drugs have received Food and Drug Administration (FDA) approval to treat ROP specifically, several drugs approved for other uses are being explored as alternatives to laser therapy, or for use in conjunction with it.
Prevention of Retinopathy of Prematurity
There are several ways to prevent ROP, including:
- Mimicking the intrauterine environment after preterm birth
- Prevent postnatal toxic effects (e.g., excess oxygen)
- Provides missing intrauterine factors (eg, insulin growth factor) and possibly reduces other complications of preterm birth and ROP.
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The eyes are the windows for your little one to see his new world. Checking his eye condition regularly can protect your child from the risk of complications fromretinopathy of prematurityand other diseases.
Republished with permission from theAsianParent Indonesia
