Many Premature Babies Risk Blindness with no Eye Screening in NICUs – Study

Neonatal Intensive Care Units (NICUs) in two of the country’s biggest referral facilities operate babies without an eye expert to assess for Retinopathy of Prematurity (ROP), a condition that causes blindness among premature babies.

This is according to a new study done by researchers at Makerere University. The study whose findings were released on Wednesday was done between August and November 2022 and involved 214 participants including 68 healthcare workers. 

According to experts, Retinopathy of Prematurity causes abnormal development of blood vessels in the retina of premature low-birth-weight infants. The risk factors for the condition include the use of excessive supplementary oxygen, birth before 32 weeks of gestation and low birth weight of 1500 grams or less.

Dr Lusobya Rebecca Claire, an ophthalmologist who led the study team to assess the knowledge and practice of paediatricians, neonatal nurses and caregivers of preterm infants towards ROP in Kawempe National Referral and Mulago Women and Neonatal Hospitals says that they found only 49 per cent of health workers had ever been trained on screening and prevention of the condition among babies.

Lusobya says that the eyes of babies with the condition get damaged leading to bleeding and scarring which can only be seen by thorough screening. Once diagnosed early, the baby can be saved from going permanently blind.

Inadequate screening of Retinopathy of Prematurity predicts a high disease burden for Uganda, whose preterm birth rate of 13.6 per 1000 live births is ranked 28th highest in the world. The researchers recommend screening all premature babies by the time they make one month of age. But, realizing this can be a challenge especially since facilities operate with no eye specialists.

According to Dr Mary Nyanzi who heads Pediatrics at Kawempe National Referral Hospital about 80 premature babies are born at the facility every day but they operate without a dedicated eye specialist or ophthalmologist.

Nyanzi can’t determine or estimate how many babies present with this condition but reveals that at one time, a Master’s student from Makerere University was deployed at the NICU to assess for the condition and the results showed a quite high prevalence. As a result, she says, they resolved to create information materials and urged caretakers to take their children for an eye exam at one month old.

However, on the part of parents and caregivers, the researchers found that only 17 out of 146 parents of preterm babies interviewed had knowledge about the disease and its risk factors; and only three knew how to identify it. This inadequate awareness of the disease by parents further contributes to gaps in screening and testing.

With Retinopathy of Prematurity being the commonest cause of avoidable and preventable blindness among preterm babies, the researchers emphasize increased awareness of risk factors and prevention measures among caregivers and health workers through the development and circulation of health education materials.

Giving remarks about the study, Dr Denis Erima, the President of the Ophthalmology Society of Uganda said while ensuring all premature babies are assessed for eye health would be ideal, it’s not possible for all NICUs across the country to be staffed as the whole of Uganda has less than fifty specialists.

When it comes to drugs and equipment needed in assessment, the ophthalmologist said they are very expensive and government cannot guarantee consistent supply. He says currently, most of the government health facilities that have this diagnosis equipment are acquired through a global sight charity, Light for the World.  

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