Study And Evaluation Of Newborn Eye Disease Screening

[Background]"Elimination of the avoidable blindness" is promoted by World Health Organization(WHO)in 2003 to reach the goal of eye health."Children blindness" is an important component of the avoidable blindness.The "avoidable blindness" refers to those blindness-leading diseases that can be prevented or treated effectively by modern medical technology.Studies of children with visual disabilities in School for the Blind have shown that the primary two causes of children blindness in our country are retinopathy of prematurity(ROP)and congenital cataract.Both of these diseases are preventable and treatable.However,blindness caused by these two diseases is difficult to be treated because the "critical period of intervention" and"sensitive period of visual development" have been missed.Therefore,in order to prevent children blindness,the most important factor may be "promptness",and a newborn eye disease screening system and child eye care system may be necessary.Jinan Maternity and Child Care Hospital began to conduct newborn eye diseases screening back from March,2003.In September 2014,RetCam3 was introduced and applied in newborn eye disease screening.In this study,technologies,times,and outcomes of two different screening modes are compared and evaluated in order to provide basic proof for making a regular newborn eye disease screening strategy.[Objectives]To compare the outcomes and evaluate the efficiency of two different newborn eye disease screening modes in Jinan Maternity and Child Care Hospital,and evaluate the optimal time of primary screening.Part 1.Study and evaluation of two different eye disease screening modes for healthy newborns[Methods]1.Participants:Healthy newborns born in Jinan Maternity and Child Care Hospital from February 2014 to March 2015(14 months totally)were included in this study.A healthy newborn was a newborn whose gestational age≥37w,birth weight>2500g,Apgar score≥7,without any systemic disease.Newborns whose consent forms not obtained from parents were excluded from this study.2.During the first period(February 2014 to August 2014),8078 healthy newborns were screened at 2-4 days after birth.Primary screening included light reflex,external inspection and red reflex test.Newborns who meet all of the followings were recorded as "passing" the screening:1.normal light reflex,2.normal external,and 3.normal red reflex of each eye.Newborns did not pass the primary screening were referred to review or diagnosed examinations,which included external inspection by handheld slit lamp and fundus examination by indirect ophthalmoscope.During the second period(September 2014 to March 2015),8408 newborns were screened at 2-4 days after birth.The scope of fundus examination was different between two periods.In the first period,only newborns not "passing" the primary screening were referred to fundus examination by an indirect ophthalmoscope.While in the second period,RetCam fundus examination was conducted universally in all healthy newborns.Newborns who meet all of the followings were recorded as"passing" the screening:1.normal light reflex of’ each eye,2.normal external,3.normal red reflex and 4.normal fundus with no coloboma of eyeball and no opacity in ocular media.3.Gender,gestational age,birth weight,Apgar score,and outcomes of eye disease screening of each newborn were recorded in an Excel document,and were analyzed with SPSS(version:21).Chi-square test and t test were used to compare the difference between groups.P<0.05 was considered indicative of a statistically significant difference.[Outcomes]1.9 kinds of disorders(727 cases,8.99%)were detected in the first period.Among which,there were 365 cases of conjunctivitis(4.51%),219 cases of persistent pupillary membranes or pigment granules(2.71%),99 cases of subconjunctival hemorrhage(1.22%),38 cases of dacryocystitis(0.47%),2 cases of congenital cataract(0.02%),1 divided nevus of eyelid(0.01%),1 heterochromia iridis(0.01%),1 corneal dermoid cyst(0.01%),and 1 congenital ptosis(0.01%).2.During the second period,all 8408 healthy newborns were divided into two groups.Group 1 composed 765 newborns whose consent form about RetCam examination not obtained from parents.These newborns received light reflex,external inspection,and red reflex test(the same as examinations in the first period)at 2-4 days after birth.As a result,a total of 4 kinds(86 cases,11.24%)of anterior abnormalities including conjunctivitis,persistent pupillary membranes or pigment granules,subconjunctival hemorrhage,and dacryocystitis were detected in group 1.Group 2 composed the other 7643 newborns who received RetCam fundus examination in addition.As a result,there were 11 kinds(687 cases,8.99%)of anterior abnormalities including conjunctivitis,persistent pupillary membranes or pigment granules,subconjunctival hemorrhage,dacryocystitis,congenital cataract,congenital ptosis,floaters in aqueous humor,nebula,coloboma iridis,and microphthalmos,and albinism were detected.In addition,16 kinds(1955cases,25.58%)of posterior abnormalities such as retinal hemorrhage,abnormal fundus pigmentation,familial exudative vitreoretinopathy(FEVR),and retinoblastoma(RB)were detected in group 2.The most common posterior disorder was retinal hemorrhage(1680 cases,21.98%).The other three common posterior disorders were abnormal fundus pigmentation,subretinal exudative changes,and FEVR.3.Red reflex test and RetCam examination were regarded as the most important screening technology in these two periods respectively.There was no statistic difference in the incidence of anterior abnormalities between two periods.However,no posterior abnormality was detected in the first period,while a large amount of posterior abnormalities were detected in the second period and the most common abnormality was retinal hemorrhage.Part 2.Study and evaluation of two different eye disease screening modes for high-risk newborns[Methods]1.Participants:High-risk newborns born in Jinan Maternity and Child Care Hospital from February 2014 to March 2015(14 months totally)were included in this study.A newborn with high risks was a newborn whose gestational age<37w,or birth weight<2500g,or Apgar score<7,or with any systemic disease such as pneumonia or hyperbilirubinemia.Newborns whose consent form not obtained from parents were excluded from this study.2.During the first period(February 2014 to August 2014),1314 high-risk newborns were screened at the day they were discharged from hospital(about 2 to 30 days after birth).Primary screening included light reflex,external inspection,and red reflex test.Diagnosed examinations included external inspection by handheld slit lamp and fundus examination by indirect ophthalmoscope.All high-risk newborns were referred to diagnosed examinations no matter how he/she had passed the primary screening or not.Time for diagnosed examination was different according to the gestational age:full term newborns were reviewed at about 42 days after birth,while prematurity were reviewed at 30 days after birth.Prematurity may be reviewed more than once.During the second period,1405 high-risk newborns received primary screened.Time,venue and technique of primary screening of the second period were as same as the first period.Reviewing time was also the same with the first period.Reviewing technique included external inspection with hand-held slit lamp,and fundus examination conducted by RetCam.3.Gender,gestational age,birth weight,Apgar score,systematic disease,and outcomes of eye disease screening of each newborn were recorded in an Excel document,and were analyzed with SPSS(version:21).Chi-square test and t test were used to compare the difference between groups.P<0.05 was considered indicative of a statistically significant difference.[Outcomes]1.7 kinds(89 cases,6.77%)of anterior abnormalities including conjunctivitis,persistent pupillary membranes or pigment granules,dacryocystitis,subconjunctival hemorrhage,heterochromia iridis,congenital cataract,and congenital ptosis were detected in the first period.In addition,3 kinds(44 cases,3.35%)of posterior disorders including retinopathy of prematurity(ROP),hemorrhage,and persistent hyaloid artery were also detected.2.In the second period,7 kinds(104 cases,7.40%)of anterior abnormalities including conjunctivitis,persistent pupillary membrane or pigment granules,subconjunctival hemorrhage,dacryocystitis,divided nevus of eyelid,congenital cataract,and heterochromia iridis were detected.In addition,11 kinds(81 cases,5.77%)of posterior abnormalities including ROP,retinal hemorrhage,abnormal fundus pigment,subretinal exudative changes,ocular media opacity,FEVR,vitreous opacity,persistent hyaloid artery,choroidal coloboma,macular dysplasia,and vitreous hemorrhage were also detected.3.Fundus examination was conducted by indirect ophthalmoscope in the first period,and RetCam in the second period.There was no statistic difference in the incidences of anterior abnormalities and ROP between two periods.However,kinds and amounts of posterior abnormalities detected in the second period were much higher than in the first period(P<0.001).[Conclusions]1.In the first period,anterior segment of eyeball was primarily screened in this mode,and red reflex test was the most important screening technique.High-risk newborns and healthy newborns with abnormal red reflex test were examined with indirect ophthalmoscope in addition.In the second period,both anterior and posterior segment of eyeball were screened,and RetCam examination was the most important screening technique.Universal fundus examinations were conducted in healthy newborns and high-risk newborns.There was no statistic difference in anterior abnormalities between two periods.However,kinds and amounts of posterior abnormalities detected in the second period were much higher than in the first period.2.Facilities needed in the mode of screening for anterior segment of eye ball were much affordable,and the tests were much simple to be carried out in primary hospitals.Abnormalities detected by this mode were mainly anterior abnormalities.However,expensive facilities,examiners with higher level of experience,larger locality,restrict controlling of hospital infection were necessary in the mode of secreening for both anterior and posterior segment of eyeball.Comparatively,more posterior abnormalities were detected in this mode,which made preventive intervention of blindness-causing diseases possible.3.Newborn eye disease screening provides a good chance for early detection and preventive intervention of eye diseases that affect visual development.It may be better that healthy newborns be screened at 2-4 days after birth(or before being discharged),prematurity be screened at correct gestational age of 31-32 w,and full term high-risk newborns be screened as early as possible once their physical conditions permitted.