ROP_Parade3

Should the Lights be Dimmed?
by Bernard Gavzer
Last June, Parade reported on possible damage done to the developing eyes of premature newborns by hospital lighting. Since then, new information has emerged.

Each year in the U.S., 400 to 600 premature, low-birthweight babies are blinded by a disorder called retinopathy of prematurity (ROP), often while in neonatal intensive-care units. In 1995, researchers seeking the cause of this disorder undertook a $1.2 million "Light-ROP" study, in which light- shielding goggles were placed on premature infants.

The goggles were used to test whether exposure to the fluorescent lighting found in hospitals caused the disorder. The study's results, published in the May 28,1998, edition of The New England Journal of Medicine, have heightened the controversy.

"We found that light reduction does not reduce the frequency of retinopathy of prematurity in infants at high risk for this disorder," the study's authors wrote.

But that finding is contradicted by the preliminary recommendations of a second study, which says that "intense light may damage the developing retina". This study, "The Physical and Developmental Environment of the High-Risk Newborn Center Program", expected to be published next year, was begun in 1992 and is headed by Dr. Stanley Graven of the University of South Florida at Tampa. It was financed by an $800,000 grant from the U.S. Public Health Service.

Critics cited these points as flaws in the Light-ROP study:

Only 26 of the 188 babies fitted with goggles got them within six hours of birth. The other 162 went as long as 24 hours without them. Critics contend this was enough to trigger damage.
The monitoring devices initially used to measure light exposure in the study failed.

The Light-ROP study -- financed by the National Eye Institute -- was led by Dr. James D. Reynolds, chief of pediatric ophthalmology at the Children's Hospital in Buffalo, N.Y.

"The preponderance of evidence is against light having any negative effect on the retina," said Dr. Reynolds, who also served on the light subcommittee of Dr. Craven's study. "But I wouldn't swear that things are definitive."

Critics, however -- particularly activist parents of blinded children -- quickly condemned the Light-ROP report.

"We predicted the report would be a whitewash, because it was flawed", said Margaret Watson, founder of the nonprofit organization Prevent Blindness in Premature Babies Inc., in Madison, Wis. Her daughter, Katie, 9, went blind while in intensive care. "The infants in the study were not fitted with protective goggles for hours," said H. Peter Aleff, an engineer from Vineland, NJ, whose son, David, 13, also was blinded by ROP.

In response. Dr. Reynolds agreed that some criticism was valid. "The trial was well designed," he said, "but it did not put goggles on the babies in the delivery room." He also acknowledged that the monitoring devices did indeed malfunction, but he feels this did not adversely affect the results.

While doctors, scientists and parents fight it out, neonatal nurses have acted independently to protect infants.

"We didn't need any study to see that the babies did better when shielded from bright light and noise", said Gay Gale, a neonatal nurse at Children's Hospital in Oakland, Calif.

Gay Gale, a nurse at Children's Hospital in Oakland, Calif., places a cover over the incubator of Fallon Shea O'Neill to keep out light and noise.
Photo by Gerry Gropp.

In 1992, she made a pink corduroy cover for an incubator. The covers are popping up in hospitals across the country. "The babies seem to be doing much better", said Sandra Swanson, neonatal nurse manager at Ronald McDonald Children's Hospital of Loyola in Maywood, Ill.

Meanwhile, the controversy continues. "No single study is definitive", Dr. Reynolds said. "The question is this: Is there enough evidence now to warrant more money being spent on this investigation, or should it go another way?"

H. Peter Aleff's response to this question echoes the frustrations of other parents of children with ROP: "Let's make nurseries more friendly to babies by reducing light and sound. Surely no one says that is dangerous."

For more information on ROP, send a self-addressed, stamped envelope to: Prevent Blindness in Premature Babies Inc., Dept. P, P.O. Box 44792, Madison, Wis. 53744-4792. Or visit the National Eye Institute at www.nei.nih.gov on the Web.