November 17th of every year is celebrated as the World’s Prematurity Day. This years edition was themed “Born Too Soon: Providing The Right Care, At The Right Time And At The Right Place”. I was fortunate to be present for a conference in commemoration of the 2019 World Prematurity Day at the University of Benin Teaching Hospital, Benin City, Nigeria. Amongst the many complications associated with prematurity, one that was emphasized in this conference was Retinopathy of Prematurity (ROP).
Retinopathy of Prematurity is one of the leading cause of blindness in premature infants otherwise called children born too soon or preemies.
The second part of the lecture hammered on the risk factors that affect the development of ROP and amongst the risk factors include the age of mother, certain drugs, infections, etc. Emphasis was made on prevention of ROP and that means issues bordering on prematurity have to be bluntly addressed, as ROP only occurs in prematurity.
In contrast to some developed climes where babies born at 22 weeks gestation( that is, 22 weeks of pregnancy), babies born at even 30 weeks still die in resource-poor countries of the world, where the normal gestational period is 37-40 weeks.
The major factor responsible for this is the lack of adequate medical care for premature babies in developing countries. Premature babies need more care because most of their organs are not fully developed.
Particularly in the eyes, blood vessels supplying the retina of the eyes where images are produced may not be fully developed at the time of prematurity. And because of the lack of nourishment to the eyes, the retina may get detached and vision may become impaired or totally lost in children born too soon. This can be very disastrous for the child and the entire family, not because the child has gone blind but actually because it could have been prevented. So how can it be prevented?
Prevention of Retinopathy of Prematurity
At the conference organized at the University of Benin Teaching Hospital to commemorate the World Prematurity Day, one of the prestigious speakers had insisted that proper screening of the eyes should be done for a child that was born prematurely.
Eye examinations consist of periodic examination of the retina or the back of the eye in a procedure referred to as fundoscopy. The instrument used is the ophthalmoscope. With this simple handheld instrument, a lifetime unwarranted blindness or visual impairment can be prevented.
Prematurity does not infer that the child would not make it productively. Although there may be a minimum age of viability below which the child may not survive despite all interventions. This may be practically explained by the fact that major organs like the brain, liver and kidneys may not be optimally developed then.
Some raised the question of whether or not to allow premature babies to live considering the many complications associated with their birth conditions. But it is always interesting to know that with advancing medical care, many countries have been able to savage children born at ages as low as 22 weeks gestation. And just to mention but a few of many prematurely born babies who have risen to great pedestals, are the likes of Isaac Newton, Albert Einstein, Stevie Wonders, Churchill Winston, and Charles Darwin.
The notable scholar who delivered one of the two lectures at the World Prematurity Day 2019 at the University of Benin Teaching Hospital who has excelled greatly in the medical profession also confessed that she too was in fact, a preemie (that is, premature born). And to refute claims pointing to the elimination or rejection of prematurely born children as not fit for survival is only to take the step that would have stopped Newton, Einstein, Wonders, Churchill, Darwin and many others from being born. It would have been a great loss to our world, can you deny that?
However, the complications that follow prematurity can be very grave as I have mentioned earlier. Of focus at the conference is Retinopathy of Prematurity which I have begun delving into. Others include failure to thrive, mental retardation, severe jaundice and even death.
For retinopathy of prematurity, screening must start soon after birth and must continue till the retinal vessels are fully formed like I have mentioned earlier.
The flame wire appearance of the retinal blood vessels begins development from the optic disc area of the retina and progresses towards the periphery. Not until the entire area of the retina is fully vascularized with blood vessels can we say that they are fully developed.
That means the retina must be examined throughout life until there is evidence that the entire retina has been vascularized. The final outcome of inadequately formed retinal blood vessels is the detachment of the retina from the back of the eye and subsequently blindness.
Stevie Wonder who was born six weeks earlier has had to become blind in later life just because there was no special attention to continued retinal examination to confirm that it has been fully developed before interventions were discontinued.
Retinopathy of prematurity has become the leading cause of blindness in children. And amongst other disorders associated with prematurity, the principles of management, control and prevention of retinopathy of prematurity correlates perfectly with the theme of the 2019 World Prematurity Day ” Born Too Soon: Providing The Right Care, At The Right Time And At The Right Place”.