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Recently, we were surprised by the news that in the USA we managed to keep a newborn baby who weighs 270 g and is said to be doing well. Has another barrier to saving babies born too early have been crossed?
Next Sunday, January 8, the jubilee XX Final of the Great Orchestra of Christmas Charity. The orchestra will once again play for the youngest patients and their mothers. The collected money will allow the purchase of the most modern devices to save the lives of premature babies and insulin pumps for pregnant women with diabetes. Onet – as every year – plays together with the Great Orchestra of Christmas Charity!
About seven percent of newborn babies in Poland are premature babies, i.e. newborns born into the world w 36 weeks of gestation or less with a body weight of less than 2500 g. If the baby is born before the 22nd week of pregnancy, the delivery is considered a miscarriage because of the extreme immaturity of the baby’s body and no chance of surviving outside the womb. On the other hand, deliveries before the beginning of the 8th month of pregnancy are classified as extreme prematurity.
Retinopathy of premature babies in Poland
It is important to realize that this is a group of children that requires special treatment, extremely intensive medical care for a longer period than in term babies. Neonatologists caring for premature babies face many serious medical problems resulting from the immaturity of these tiny babies’ organisms. One of them is the risk of eyesight with a disease called Retinopathy of Prematurity (ROP). In Poland, between 1998 and 1999, retinopathy was diagnosed in approximately 22 percent of premature babies. The latest statistics say about 19 percent. This is changing because the condition of newborn babies is changing, and the diagnostic and therapeutic possibilities are also increasing.
Causes of retinopathy of premature babies
Prof. dr hab. n. med. Mirosława Grałek, Professor and Consultant at the Pediatric Ophthalmology Clinic of the Medical University of Lodz, for many years she dealt with the problem of retinopathy of premature babies, incl. at the Children’s Health Center in Warsaw. – This miniature newborn from the USA – says the professor – is definitely at risk of developing retinopathy of premature babies, because the general cause of this disease is the low birth weight of the child and the early gestational age at which it was born. The younger the child is, the greater the risk of this disease.
Retinopathy is the abnormal development of the vessels in the retina after a baby is born prematurely. It is related to the interrupted process of the child’s maturation in the womb. Normal retinal vessels develop until the 40th week of pregnancy, throughout the period of intrauterine development. Premature birth disrupts this normal process. Some children develop uncontrolled growth of vessels in the retina, then in the vitreous, which causes vision impairment or even loss of visual acuity. In 90 percent of cases, the retinopathy resolves without treatment, but the remaining children develop the disease.
Who will the Great Orchestra of Christmas Charity help – read more at Medonet
Diagnosis and treatment
Prof. Mirosława Grałek emphasizes that in order to save a child’s eyesight, it is necessary to catch the disease at an early stage and start treatment as soon as possible. Ophthalmological care for premature babies is carried out according to strictly established rules. Children are examined by ophthalmologists at four, eight and twelve weeks of age, and later in the first year of life and before going to school (the consequences of retinopathy may also appear in the older age of the child). The aforementioned examination dates allow to recognize the individual phases of retinopathy and initiate treatment. Only early diagnosis and treatment of retinopathy of premature infants can prevent irreversible damage to the eyes and save a baby’s eyesight.
Studying a baby in an incubator is not easy. It requires very good preparation on the part of the doctor and specific skills – extraordinary precision and delicacy. You need knowledge, awareness of when retinopathy develops, and tracking of retinopathy at appropriate intervals. It is one of the most difficult ophthalmological examinations. Eyesight examination of children is performed with the help of specula – ophthalmoscopes. It is important to monitor that the retinal vascularization is normal, and if not, start treatment at the right time. Currently, it is primarily laser therapy – destruction of the abnormal part of the retina with a laser beam. Laser therapy turned out to be a safer and more effective method than previously used cryotherapy. The indirect ophthalmoscope, which the doctor uses to examine the child’s retina, is also used in conjunction with the attachment with which the laser eye surgery is performed. Cryotherapy is reintroduced only in cases where the laser cannot be used – for example, in young children it is not always possible to reach the damaged part of the retina with a speculum. If cryotherapy or laser therapy is not effective in stopping retinal detachment, surgery may be performed. But the standard method at the moment is laser therapy – emphasizes prof. Grałek and adds that despite the effective treatment of retinopathy, the child may suffer from visual disturbances at a later age. Retinopathy has a worse course of other consequences of prematurity, which include refractive errors, e.g. myopia or astigmatism, strabismus, late retinal detachment. Sometimes I say – notes the professor – that you are premature all your life.
The Great Orchestra of Christmas Charity and the Premature Retinopathy Treatment Program
We owe the fact that we can effectively help premature babies in Poland Fundacja Wielka Orkiestra Świątecznej Pomocywhich has been implementing a program for the prevention and treatment of retinopathy of premature infants for several years. Professor Mirosława Grałek is the coordinator of this program and on every occasion emphasizes the enormous contribution of the Great Orchestra of Christmas Charity Foundation in saving the eyesight of premature babies. The Foundation donated 98 specula (ophthalmoscopes) and 15 diode lasers to neonatal and ophthalmic departments. This equipment was evenly distributed throughout Poland. Thanks to him, 16 children were examined last year alone. A certain percentage (4,97%, i.e. 824 premature babies) were diagnosed with retinopathy in the stage requiring laser therapy. The treatment was successful in 796 newborns (i.e. 96,6% of those who underwent laser therapy). This group of children avoided blindness. It would seem that the problem of retinopathy has been solved by medicine. However, not entirely. Huge advances in neonatology are saving the lives of ever younger premature babies. These are smaller and smaller children, often weighing less than 1000 g, born at 22, 23 and 24 weeks of pregnancy, who are at a much greater risk of developing retinopathy than later born premature babies. The earlier a baby is born, the longer the blood vessels of his retina develop outside the womb and the more vulnerable they are to pathology. We are trying to outsmart the disease – says prof. Grałek – using new diagnostic and treatment possibilities, but the disease “takes revenge”. Hence, in these youngest premature babies, a new form of retinopathy, previously unknown, is encountered. a thundering back figure. In this case, vascular pathological changes are limited to the back of the eye, where the optic nerve and the retinal area responsible for good vision are located.. This type of retinopathy has become a new challenge for pediatric ophthalmologists, but it cannot be said that its treatment is always successful.
However, new knowledge comes to the rescue again. In recent years, in the world, but also in Poland (e.g. in Warsaw, Łódź), a method of treating retinopathy has been introduced, whereby the child is given a factor that inhibits the growth of vessels. It is a preparation from the group of monoclonal antibodies – Ranibizumab – applied topically to the eyeball by injection. Thanks to it, you can achieve good results in the treatment of the youngest premature babies.
Text: Barbara Skrzypińska
We manage to save smaller and smaller premature babies – read more