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Red reflex examination in neonates: evaluation of 3 years of screening
Carlo Cagini1, Gianluigi Tosi2, Fabrizio Stracci3
1Division of Ophthalmology, Department of Surgical and Biomedical Sciences, Ospedale S. Maria della Misericordia, University of Perugia, S. Andrea delle Fratte, 06156, Perugia, Italy. carlo.cagini@unipg.it.
Insights
The red reflex test, a simple screening for newborns, effectively detects serious eye conditions like congenital cataract and retinoblastoma. This low-cost method should be standard in neonatal care for early detection of vision impairments.
Area of Science:
- Ophthalmology
- Neonatal Care
- Public Health Screening
Background:
- The red reflex test is crucial for identifying potentially sight-threatening ocular abnormalities in newborns.
- Early detection of congenital eye diseases is vital for effective treatment and visual development.
- Screening programs aim to integrate this test into routine neonatal assessments.
Purpose of the Study:
- To evaluate the effectiveness of the red reflex screening campaign in Umbria, Italy, over its first three years (2012-2014).
- To report the incidence of detected ocular abnormalities in newborns screened using the red reflex test.
Main Methods:
- Red reflex screening was conducted in 11 regional birth centers on newborns within three days of life.
- Infants with positive or equivocal results were referred for further ophthalmological evaluation.
- A multi-level referral system directed patients to specialized university hospital departments when necessary.
Main Results:
- Out of 22,272 newborns screened (97.3% coverage), 4.83% had positive or equivocal results.
- Three neonates (0.01%) were diagnosed with significant eye diseases: two with congenital cataract and one with retinoblastoma.
- The screening identified critical cases despite a high rate of false positives.
Conclusions:
- The red reflex test is a valuable, cost-effective, and easily implementable tool for early detection of congenital low vision diseases.
- Despite a notable number of false positives, the test's ability to identify serious conditions like congenital cataract and retinoblastoma supports its inclusion in standard neonatal evaluations.
- The findings reinforce the importance of red reflex screening as a routine part of neonatal care to prevent long-term visual impairment.
Purpose:
Red reflex is a test that can detect potentially life-threatening ocular abnormalities. In 2012, a red reflex screening campaign was started in Umbria, central Italy. In this study, we report the results of the first 3 years (2012-2014) of screening.
Methods:
Red reflex screening was carried out in the 11 regional birth centres. On the first level, the test was performed on all newborns within the third day of life. A pathologic test was an indication for referral to the nearest Ophthalmology Hospital Department (II level). Patients were referred to the Perugia University Ophthalmology Hospital Department if an ulterior evaluation or if treatment was necessary (III level).
Results:
Between 1 January 2012 and 31 December 2014, 22,884 children were born in Umbria and of these, 22,272 (97.3%) were tested with the red reflex. Four hundred and sixty-one (4.83%) neonates resulted having a positive or equivocal test and were sent to II level. Three of these cases (0.01%) were affected by an important eye disease, in particular two patients (0.009%) presented congenital cataract and one patient (0.005%) presented retinoblastoma.
Conclusion:
Our results are consistent with the previous findings, although reports on red reflex screening are sporadic in the literature. Despite the high number of false positives, the red reflex test has proven to be a useful, easy to perform and low cost test for the early detection of congenital low vision diseases, and our data confirm that it must become part of normal neonatal assessments.
