Screening program identified clinically significant eye diseases in a significant percentage of healthy babies.

Screening for ocular pathology in newborn children may lead to early detection and treatment of eye diseases, which may in turn help to preserve visual function and prevent blindness in these children. We performed a study to establish the effectiveness of an eye-screening program to detect ocular pathology in healthy, full-term neonates in our facility.

The Maternal and Children's Hospital is located in Kunming, the capital of Yunnan province in China. In a 27-month period beginning in May 2010 we screened 8439 healthy neonates; 7863 were gestational age 37 weeks or more at birth, and 576 were less than 37 weeks. On average, not including preterm infants, screening took place 2.89 days after birth. The screening rate was high, capturing 88.29% of all babies born in the hospital. Excluded from screening were those with systemic disease or whose mothers had a sexually transmitted disease.

The screening exam included external eye examination, pupillary light reflex, red reflex, opacity of refractive media, and anterior and posterior segment examination. Equipment used included flashlight, retinoscope, hand-held slit-lamp biomicroscope, and a wide-angle digital retinal image acquisition system (RetCam II, Clarity Medical Systems). Five retinal images were taken at different angles in each eye to provide a complete picture of retinal status.

Results

Among the babies screened, 76.81% were (thankfully) normal. Identified as abnormal were 23.19%, including 20.96% with retinal hemorrhage and 2.28% with other pathologies. There was a long list of other abnormalities, each seen in small percentages of patients, including subconjunctival hemorrhage, familial exudative vitreoretinopathy, abnormal fundus pigment, ocular dysplasia, lacrimal duct obstruction, retinal venous tortuosity, congenital cataract, retinoblastoma, optic nerve coloboma, and microphthalmos. No differences in incidence of abnormalities were seen between male and female patients.

Some screening results were compiled separately for the entire infant population (n = 8439) and for term infants (n = 7863) to allow comparisons. There were no differences between the 2 populations in the incidence of retinal hemorrhage (20.96%) or significant retinal hemorrhage (grade 3 or greater; 6.1%). For macular hemorrhage, however, the incidence was 2.7% in the total population and 1.87% in the term babies. There was also a difference in the rate of other abnormalities between the total population (2.22%) and the term babies (2.99%).

As noted, the rate of retinal hemorrhage was high, at more than 20% in both populations. Among the infants with retinal hemorrhage, the incidence of macular hemorrhage was 8.27%, and 8 eyes had foveal hemorrhage.

Within 20 days, 85% of hemorrhages were absorbed. For macular hemorrhages, however, it took longer— 3 weeks to 3 months—for the hemorrhages to absorb.

Interestingly, the incidence of hemorrhage was higher in natural-birth babies (33.7%) than in those delivered by cesarean section (4.76%). Also, the incidence of hemorrhage was higher when the infant had a shorter birth process as opposed to a longer birth process.

Implications

Identification of certain pathologies allowed treatment to be performed in a timely fashion. For example, in 2 children in whom retinoblastoma was identified by screening at 3 days after birth (in 1 case, bilateral retinoblastoma), surgery was successfully performed. These children are now 2 and 3 years old and healthy with good vision.

With the program now in place for less than 3 years, we cannot yet say what the long-term results of universal ocular screening of neonates will be. We hope to be able to continue this neonatal screening program and to follow these children for 5 to 10 years to track the results.

We can say that universal newborn eye screening has revealed clinically significant eye diseases in a significant percentage of healthy babies. The incidence of eye diseases is 2 to 3 times greater than the incidence of hearing defects identified in screening of healthy newborns. Evaluation of the natural history of these diseases and the impact of early intervention is ongoing. We hope this program will lead to opportunities for improvements in public health.

Li Li-Hong, MD, is a Pediatric Ophthalmologist at Maternal and Children's Hospital in Kunming, China. Dr. Li states that she has no financial relationships to disclose. She may be reached at Maternal and Children's Hospital, Kunming 650031, Yunnan, China.