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Early light reduction for preventing retinopathy of prematurity in very low birth weight infants
Eliane C Jorge1, Edson N Jorge, Regina P El Dib
1Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Distrito de Rubião Júnior, s/n, Botucatu, São Paulo, Brazil, 18618-970.
Insights
Reducing light exposure for premature infants does not decrease retinopathy of prematurity (ROP) incidence. This study found no effect of reduced light on ROP outcomes in very low birth weight infants.
Area of Science:
- Neonatal ophthalmology
- Perinatal medicine
- Public health
Background:
- Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness in premature infants.
- While immaturity and oxygen therapy are known risk factors, the role of other factors like light exposure is less understood.
- Understanding ROP's multifactorial nature is crucial for effective prevention strategies.
Purpose of the Study:
- To evaluate if reducing early environmental light exposure impacts the incidence or severity of ROP in very low birth weight infants.
- To determine the effectiveness of light reduction as an intervention for ROP prevention.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials.
- Searched major medical databases (Cochrane, MEDLINE, EMBASE, etc.) and clinical trial registries.
- Included trials reducing light exposure in premature infants within the first seven days of life.
Main Results:
- Four trials involving 897 participants showed no significant reduction in acute ROP or poor ROP outcomes with reduced light exposure.
- Methodological quality of included studies was mixed, with some at low risk of bias.
- Secondary outcomes like quality of life and oxygen exposure time were not reported.
Conclusions:
- Current evidence indicates that bright light is not a primary cause of ROP.
- Reducing light exposure for premature infants does not alter the incidence or progression of ROP.
- Further research may be needed to explore other environmental factors influencing ROP.
Background:
Retinopathy of prematurity (ROP) is a complex condition of the developing retinal blood vessels and is one of the leading causes of preventable childhood blindness. Several risk factors for ROP have been studied over the past 50 years. Among them, general immaturity (low birth weight and low gestational age) and prolonged oxygen therapy have been consistently related to disease onset. However, it is understood that the progression of the disease is multifactorial and may be associated with others risk factors, such as multiple gestation, apnoea, intracranial haemorrhage, anaemia, sepsis, prolonged mechanical ventilation, multiple transfusions and light exposure. Furthermore, the precise role of these individual factors in the development of the disease has not yet been well established.
Objectives:
To determine whether the reduction of early environmental light exposure reduces the incidence of retinopathy of prematurity (ROP) or poor ROP outcomes among very low birth weight infants.
Search Methods:
We searched the following databases: the Cochrane Neonatal Group Specialised Register, CENTRAL (The Cochrane Library), MEDLINE, EMBASE, CINAHL, HealthSTAR, Science Citation Index Database, CANCERLIT, the Oxford Database of Perinatal Trials and www.clinicaltrials.gov. We also searched previous reviews including cross-references, abstracts, conference and symposia proceedings, and contacted expert informants. This search was updated in October 2012.
Selection Criteria:
Randomised or quasi-randomised controlled trials that reduced light exposure to premature infants within the first seven days following birth were considered for this review. We also considered cluster-randomised controlled trials.
Data Collection And Analysis:
Data on clinical outcomes including any acute ROP and poor ROP outcome were extracted by both review authors independently and consensus reached. We conducted data analysis according to the standards of the Cochrane Neonatal Review Group.
Main Results:
Data from four randomised trials with a total of 897 participants failed to show any reduction in acute ROP or poor ROP outcome with the reduction of ambient light to premature infants' retinas. The overall methodological quality of the included studies was about evenly split between those in which the classification was unclear and those in which the studies were categorised as low risk of bias. There was no report on the secondary outcomes considered in this review: quality of life measures; and time of exposure to oxygen.
Authors' Conclusions:
The evidence shows that bright light is not the cause of retinopathy of prematurity and that the reduction of exposure of the retinas of premature infants to light has no effect on the incidence of the disease.
