Early light reduction for preventing retinopathy of prematurity in very low birth weight infants

 

Abstract

Background

Retinopathy of prematurity (ROP) causes vision loss in many premature infants each year, despite the advances being made in treatment. In the search for ways to prevent the disease altogether, the exposure of the retina to bright ambient light following premature birth has been a natural hypothesis, since the premature infant normally would be in the dark in-utero environment. Several controlled studies have now addressed this theory.

Objectives

To answer the question: "Among very low birth weight infants, what is the effect of reducing early environmental light exposure on the incidence of any "Acute ROP", or "Poor ROP Outcomes"?

Search methods

Searches were made of the Cochrane Neonatal Group Register of Controlled Trials, Medline, EMBASE, the Cochrane Library, previous reviews including cross references, abstracts, conference and symposia proceedings, and expert informants. The search terms used were [retrolental fibroplasia or retinopathy of prematurity] and [light or light/ae or lighting or lighting/ae or light/tu or lighting/st]. This search was updated as of November 2000.

Selection criteria

Randomized or quasi-randomized controlled trials that reduced light exposure to premature infants within the first 7 days following birth were considered for this review.

Data collection and analysis

Data on clinical outcomes including any Acute ROP and Poor ROP Outcome were excerpted by both reviewers independently and consensus reached. Data analysis was conducted according to the standards of the Neonatal Cochrane Review Group.

Main results

Data from four recent randomized trials, and one much older quasi-randomized trial failed to show any reduction in Acute ROP, or Poor ROP Outcome with the reduction of ambient light to premature infants' retinas. The number of infants studied to date allows 95% confidence that IF there were a true difference being missed, it would be smaller than 7 percentage points on a background of 54% of all infants under 2 kg developing ROP.

Authors' conclusions

Decreasing retinal ambient light exposure in premature infants is very unlikely to reduce the incidence of ROP.

 

Plain language summary

Early light reduction for preventing retinopathy of prematurity in very low birth weight infants

Retinopathy of prematurity can cause vision loss in premature infants. One theory was that bright light after birth started off the injury that led to vision loss. Considerable research has been done on this and it now appears fairly certain that bright light is not the cause of this problem, and it does not add to the problem.

 

Abstract

Rano smanjenje svjetla za sprječavanje prematurne retinopatije kod novorođenčadi s izrazito niskom porođajnom težinom

Background

Retinopathy of prematurity (ROP) causes vision loss in many premature infants each year, despite the advances being made in treatment. In the search for ways to prevent the disease altogether, the exposure of the retina to bright ambient light following premature birth has been a natural hypothesis, since the premature infant normally would be in the dark in-utero environment. Several controlled studies have now addressed this theory.

Objectives

To answer the question: "Among very low birth weight infants, what is the effect of reducing early environmental light exposure on the incidence of any "Acute ROP", or "Poor ROP Outcomes"?

Search methods

Searches were made of the Cochrane Neonatal Group Register of Controlled Trials, Medline, EMBASE, the Cochrane Library, previous reviews including cross references, abstracts, conference and symposia proceedings, and expert informants. The search terms used were [retrolental fibroplasia or retinopathy of prematurity] and [light or light/ae or lighting or lighting/ae or light/tu or lighting/st]. This search was updated as of November 2000.

Selection criteria

Randomized or quasi-randomized controlled trials that reduced light exposure to premature infants within the first 7 days following birth were considered for this review.

Data collection and analysis

Data on clinical outcomes including any Acute ROP and Poor ROP Outcome were excerpted by both reviewers independently and consensus reached. Data analysis was conducted according to the standards of the Neonatal Cochrane Review Group.

Main results

Data from four recent randomized trials, and one much older quasi-randomized trial failed to show any reduction in Acute ROP, or Poor ROP Outcome with the reduction of ambient light to premature infants' retinas. The number of infants studied to date allows 95% confidence that IF there were a true difference being missed, it would be smaller than 7 percentage points on a background of 54% of all infants under 2 kg developing ROP.

Authors' conclusions

Decreasing retinal ambient light exposure in premature infants is very unlikely to reduce the incidence of ROP.

 

Plain language summary

Rano smanjenje svjetla za sprječavanje prematurne retinopatije kod novorođenčadi s izrazito niskom porođajnom težinom

Rano smanjenje svjetla za sprječavanje prematurne retinopatije kod novorođenčadi s izrazito niskom porođajnom težinom

Prematurna retinopatija može uzrokovati gubitak vida kod nedonoščadi. Prema jednoj teoriji jarka svjetlost nakon rođenja započinje ozljedu koja dovodi do gubitka vida. Značajan broj istraživanja je napravljen na ovu temu te se sad s priličnom sigurnošću može utvrditi da jarka svjetlost nije uzrok ovog problema te mu ne doprinosi.

Translation notes

Translated by: Croatian Branch of the Italian Cochrane Centre
Translation Sponsored by: Ministry of Education, Science and Sports

 

摘要

背景

降低早期光線曝露對於預防極低體重兒的早產兒視網膜病變之效應

儘管治療進步，早產兒視網膜病變(ROP)每年仍造成很多早產兒視力之喪失。在尋求預防此疾病的方法過程中，在早產的情況下視網膜暴露於週遭明亮的光線是造成此病變的自然假說，因為在正常情形下早產兒應是處於陰暗的子宮內環境。有幾項對照試驗目前已經提出了這個理論。

目標

回答此問題︰針對極低出生體重兒，降低早期環境光線曝露對於任何”急性ROP發生率或是”較差之ROP預後“之效應為何？

搜尋策略

搜尋 Cochrane Neonatal Group Register of Controlled Trials, Medline, EMBASE, the Cochrane Library, 以前的回顧文章包括共用的參考文獻、摘要、會議和專題討論會紀錄、以及專家資訊。使用的檢索關鍵字是 [retrolental fibroplasia or retinopathy of prematurity] 和 [light or light/ae or lighting or lighting/ae or light/tu or lighting/st]。此搜尋在2000年11月被更新

選擇標準

在出生後7天內降低早產兒光線曝露的隨機或半隨機對照試驗探被列入本回顧中。

資料收集與分析

臨床結果的數據包括急性之ROP或是較差之ROP後果由兩名評論家分別摘錄並達成共識。數據分析根據Neonatal Cochrane Review Group之標準。

主要結論

4個最近的隨機試驗及1個較舊的半隨機試驗的結果，無法顯示降低早產兒視網膜接受的環境光線能減少急性ROP或是較差之ROP後果。到目前為止研究嬰兒的數量允許95%可信度為,在小於2公斤的嬰兒有54%產生ROP的背景下，若有真實的差異被忽略其機會將會小於7個百分點。

作者結論

減少早產兒視網膜的環境光線暴露非常不可能降低ROP的發生機率。

翻譯人

本摘要由臺中榮民總醫院陳信利翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

早產兒視網膜病變可能導致早產兒的視覺喪失。其中一個理論是出生後明亮的光線會引起傷害而導致視覺喪失。目前已有很多相關的研究，並能幾乎確定指出明亮的光線不是這個問題的起因，也不會加重這個問題。