Every day babies are born prematurely. According to the new order, in our country children born on the period of 22 weeks of gestation are subject to resuscitation and further nursing. Now there is a chance for life even for the tiniest babies whose birth weight does not exceed 1 kg. These children are not just small, they have extreme immaturity of almost all body systems.

Yes, thanks to the achievements of resuscitation care, they began to survive more often. However, along with this, the number of disabling diseases of premature babies has increased. In this article, we will talk about one of these conditions, namely, retinopathy of premature infants.

What is premature retinopathy?

Retinopathy of premature babies is called a severe pathology of the organ of vision in children born earlier than expected. The disease is formed under the influence of a number of factors that interfere with the proper maturation of the retinal vessels, which in some cases leads to its detachment and blindness.

Among the variety of causes of childhood blindness in developed countries, it is retinopathy of premature infants that occupies one of the first places. The more children nursed in the country who were born with a body weight of up to 1 kg, the more cases of retinopathy are noted among the population.

Why are premature babies prone to retinal damage?

Children who were born before reaching 32 weeks of pregnancy make up the bulk of the risk group for the development of retinal pathology. These are babies whose body weight at birth is considered very low (1000-1500 g) and extremely low (less than 1000 g). Why it happens?

The basis for the development of retinopathy in premature infants is immaturity and insufficient formation of the retina at the time of the birth of the baby. Until 16 weeks of pregnancy, there are no vessels in the retina of the fetus. And from this period, vascular growth begins, which occurs from the center of the retina to the periphery. In parallel, the formation of the retina itself occurs. These processes should be completed by the planned appearance of the baby (that is, when he is already full-term). This happens under the influence of various growth factors.

When a baby is born much ahead of schedule, all processes of normal retinal maturation are disrupted, which proceeds in two phases. First, the normal growth of the retinal vessels stops. Then begins the pathological proliferation of blood vessels, which corresponds to the active stage of the disease.

Risk factors for premature retinopathy?

Do all premature babies develop retinopathy? No, not all retinopathy develops. Moreover, the disease can be of varying severity in children of the same gestational age. What is the reason for this?

The following factors contributing to the development of the disease are distinguished:

• Severe respiratory disorders in the baby;
• The need for mechanical ventilation, prolonged oxygen therapy;
• Concomitant congenital heart defects;
• Pathology of the nervous system due to lack of oxygen (hypoxia);
• Unstable blood sugar in a baby;
• The course of infectious diseases, etc.

How serious the deviations will be depends also on the conditions of nursing the crumbs, their care and treatment.

How to suspect a disease?

All premature babies at risk for developing retinopathy must be examined by an ophthalmologist no later than the fourth week of life. The first signs of the disease can sometimes be noted already at this examination.

The next examination is carried out no later than the sixth week of life. Then, an examination is carried out every two weeks until the retina has completed its development. In cases where signs of retinopathy are detected, examinations by an ophthalmologist are performed weekly.

Suspicion of a malignant form of retinopathy requires an even more frequent examination of the baby: once every 2-3 days.

Stages of the disease and phase

Premature retinopathy has a complex classification. It reflects the stages of the disease and the unit according to the localization and prevalence of the process. This is necessary in order to clearly determine the severity of the disease and choose the right treatment.

• Active retinopathy. This is the first phase of the disease, which lasts from 3 to 6 months.

5 stages of the active period of the disease are distinguished. A diagnosis and the severity of the process can only be done by an ophthalmologist when examining the fundus of the baby. The gradual pathological growth of the retinal vessels, their tortuosity and expansion, as well as changes from the vitreous body of the eye reflect the severity of 1-3 stages of the disease.

At stages 1 and 2 of the disease, the process can regress even without medical intervention, without leaving behind pronounced changes. At stage 4, partial retinal detachment occurs, and at stage 5, it is already complete. It is retinal detachment that causes blindness in small patients.

A special form of the disease called malignant retinopathy is also highlighted. With it, the disease progresses very quickly and is difficult to treat.

• Cicatricial retinopathy. This is the second phase of the disease. It is also called regressive. It begins either on its own, or under the influence of drugs.

The cicatricial phase can end with a full recovery or the formation of residual changes of varying severity. A total of 5 degrees of residual disturbances (from minimal to very severe) are distinguished.

How is premature retinopathy treated?

Pediatricians and neonatologists are involved in the treatment of retinopathy of premature babies with the participation of a qualified ophthalmologist. He determines the stage of the process and prescribes treatment. Treatment can be carried out both at home and in a hospital setting. However, inpatient observation of the baby is usually caused by other concomitant problems of the premature baby, and not just retinopathy.

From medicines prescribed drugs that improve the condition of blood vessels and microcirculation in tissues, antioxidants and hormonal drugs. Moreover, it is hormonal drugs that have the most significant effect. They are prescribed topically in the form of drops and in solutions for injection, which are made in the area near the eyes.

A significant effect is exerted by physiotherapy in the regression period of the disease. If the disease progresses to stages 4 and 5, surgical treatment of the child is carried out in order to preserve his vision. However, the desired effect cannot always be achieved even after surgery.

How can parents help?

Can parents somehow influence the development of retinopathy in their premature baby? Of course, they cannot intervene in the course of pathological processes taking place in an immature organism. But they can help the child get out of the neonatal intensive care unit as soon as possible. What can be done?  

• Positive emotional attitude. Oddly enough, but inner peace, trust in doctors and even just faith in a miracle really help the tiniest patients.
• Active participation in the developmental care of the baby. This includes the method of “kangaroo”, communication with the child, touching him and gentle stroking. Of course, such events are possible only with the permission of the attending physician crumbs. 
• Preservation of breastfeeding. No matter how good the mixture for a premature baby, it can never replace mother’s milk. Even in the case when the child is not soon able to attach directly to the mother’s chest, he can be fed with expressed milk. It retains its beneficial properties and helps the baby to fight dangerous infections that await him “at every turn”. And the duration of a child’s stay in intensive care directly depends on the number of such infectious complications.

Outcome and long-term prognosis

Retinopathy in premature infants with a body weight of up to 1500 g occurs in 19-47% of cases, in children with a body weight of up to 1000 g – in 54-72% of cases. It is worth noting that in babies weighing less than 750 g, retinopathy of various degrees develops in 90-100% of cases.

In recent years, significant changes have occurred in approaches to primary care for premature babies. These approaches have become more physiological, which allows you to get better long-term predictions in premature babies. A similar statement applies to retinopathy.

Stopping the pathological process and recovery of the child from the side of the organ of vision is possible only at stages 1 and 2 of the active period of the disease. With proper and timely treatment, more than 70% of these children have a good outcome.

The remaining babies have a further progression of the disease, which in some cases requires surgical treatment. This treatment does not always have an effect. According to various literature data in the structure of blindness, retinopathy of premature infants takes from 11 to 27%.

Serious Disease Prevention

Is it possible to somehow reduce the number of cases of retinopathy of premature babies? The question is very important and complex. But it can also be set with respect to all other disabling diseases of premature babies, since the prevention of all the serious consequences of the immaturity of the body of a little man should be carried out comprehensively. This is a task not of a specific person, but of our entire country.

Firstly, the biggest emphasis should be placed on the prevention of prematurity as such. This includes timely sexual education of children and adolescents, careful planning of pregnancy, a full examination of expectant mothers and proper management of pregnancy and childbirth.

Secondly, it is necessary to train qualified specialists who will provide assistance to the smallest residents of the country, as for doctors of various specialties: obstetrician-gynecologists, neonatologists, resuscitators, neurologists, ophthalmologists, etc.

Thirdly, it is very important to take a balanced and comprehensive approach to nursing and treatment of premature babies. It is not enough just to save a life; one must strive to make the future life of this person as full as possible.