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Early light reduction for preventing retinopathy of prematurity in very low birth weight infants
1Pediatrics and Ophthalmology, University of Rochester, Box 651, Pediatrics, 601 Elmwood Ave, Rochester, New York, USA, 14642. dale phelps@urmc.rochester.edu
Insights
Reducing light exposure for premature infants does not lower the risk of retinopathy of prematurity (ROP). This study found no significant difference in acute ROP or poor outcomes, suggesting light reduction is not an effective preventative strategy.
Area of Science:
- Neonatal care
- Ophthalmology
- Perinatal medicine
Background:
- Retinopathy of prematurity (ROP) is a leading cause of vision loss in premature infants.
- The in-utero dark environment suggests light exposure post-birth may contribute to ROP.
- Preventative strategies for ROP are crucial due to its significant impact on infant vision.
Purpose of the Study:
- To determine if reducing early environmental light exposure impacts the incidence of acute ROP or poor ROP outcomes in very low birth weight infants.
- To evaluate the efficacy of light reduction as a preventative measure for ROP.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials.
- Searches conducted across major databases (Cochrane Neonatal, Medline, EMBASE) and other sources up to November 2000.
- Inclusion criteria focused on trials reducing light exposure in premature infants within the first 7 days of life.
Main Results:
- Four recent randomized trials and one older quasi-randomized trial were analyzed.
- No significant reduction in acute ROP or poor ROP outcomes was observed with decreased light exposure.
- The study provides 95% confidence that any missed difference in ROP incidence is less than 7 percentage points.
Conclusions:
- Reducing ambient light exposure to the retinas of premature infants is unlikely to decrease the incidence of ROP.
- Current evidence does not support light reduction as an effective strategy for preventing ROP.
Background:
Retinopathy of prematurity (ROP) causes vision loss in many premature infants each year, despite the advances being made in treatment. In the search for ways to prevent the disease altogether, the exposure of the retina to bright ambient light following premature birth has been a natural hypothesis, since the premature infant normally would be in the dark in-utero environment. Several controlled studies have now addressed this theory.
Objectives:
To answer the question: "Among very low birth weight infants, what is the effect of reducing early environmental light exposure on the incidence of any "Acute ROP", or "Poor ROP Outcomes"?
Search Strategy:
Searches were made of the Cochrane Neonatal Group Register of Controlled Trials, Medline, EMBASE, the Cochrane Library, previous reviews including cross references, abstracts, conference and symposia proceedings, and expert informants. The search terms used were [retrolental fibroplasia or retinopathy of prematurity] and [light or light/ae or lighting or lighting/ae or light/tu or lighting/st]. This search was updated as of November 2000.
Selection Criteria:
Randomized or quasi-randomized controlled trials that reduced light exposure to premature infants within the first 7 days following birth were considered for this review.
Data Collection And Analysis:
Data on clinical outcomes including any Acute ROP and Poor ROP Outcome were excerpted by both reviewers independently and consensus reached. Data analysis was conducted according to the standards of the Neonatal Cochrane Review Group.
Main Results:
Data from four recent randomized trials, and one much older quasi-randomized trial failed to show any reduction in Acute ROP, or Poor ROP Outcome with the reduction of ambient light to premature infants' retinas. The number of infants studied to date allows 95% confidence that IF there were a true difference being missed, it would be smaller than 7 percentage points on a background of 54% of all infants under 2 kg developing ROP.
Reviewer'S Conclusions:
Decreasing retinal ambient light exposure in premature infants is very unlikely to reduce the incidence of ROP.
