Universal newborn eye screening: a systematic review of the literature and review of international guidelines

Abstract

Background This systematic review assessed the effectiveness of universal screening for newborn eye abnormalities compared with no screening in improving infant vision and health outcomes. MethodsWe searched CENTRAL (Cochrane Library), MEDLINE, Embase, Global Health, Global Index Medicus, clinical trials databases, and bibliographies of relevant articles. We included randomized and observational studies of all newborns, regardless of illness or risk factors, that compared universal screening for any eye abnormality by eight weeks of age with no universal screening. Two authors independently selected studies, extracted data, and evaluated the risk of bias. We used GRADE to assess the certainty of evidence. We also reviewed available recommendations on newborn eye screening. ResultsFourteen studies were identified but only three compared universal red reflex screening with no screening. Findings suggest that universal red reflex testing in maternity wards (MWs) may increase the number of newborns with congenital cataracts referred for eye care from MWs or well-baby clinics (WBCs) in the first year of life (risk ratio (RR) = 9.83, 95% confidence interval (CI) = 1.36-71.20; low certainty evidence). However, the effect of screening in WBC is uncertain (RR = 6.62, 95% CI = 0.87-50.09). The effect of MW or WBC screening on referral from any health care facility (MWs, WBCs, paediatrician clinic, other) in the first year is uncertain (MW screening: RR = 1.22, 95% CI = 0.63-2.39; WBC screening: RR = 0.97, 95% CI = 0.46-2.05). However, referral or surgery by 6 weeks of age may be higher with universal MW screening (early referral: RR = 4.61, 95% CI = 1.12-19.01; early surgery: RR = 8.23, 95% CI = 1.13-59.80; low certainty evidence). The effect of WBC screening on early referral and surgery is uncertain (early referral: RR = 1.98, 95% CI = 0.43-9.19; early surgery: RR = 3.97, 95% CI = 0.50-31.33; very low certainty evidence). Universal red reflex testing may increase clinical conjunctivitis (OR = 1.22, 95% CI = 1.01-1.47; low certainty evidence) but the effect on confirmed bacterial conjunctivitis is uncertain (OR = 1.20, 95% CI = 0.76-1.90; very low-certainty evidence). Nine guidelines recommended universal newborn eye screening using red reflex testing.Conclusions Evidence supports the role of red reflex testing shortly after birth to increase early identification, referral, and surgery for congenital cataracts. Registration PROSPERO (reference CRD42020180524).In 2020, 1.44 million children aged 0-14 years were estimated to be blind or severely visually impaired [1]. Most blind children are either born blind from congenital conditions or become blind before the age of 5 years from acquired conditions [2,3].

Recomendaciones de la OMS sobre cuidados maternos y neonatales para una experiencia posnatal positiva

“…Las principales causas de ceguera en los niños son las cataratas congénitas y del desarrollo, la cicatrización corneal, las anomalías oculares congénitas, las distrofias de la retina, el glaucoma y la retinopatía del prematuro. Las afecciones que están presentes al nacer se pueden detectar mediante un tamizaje durante el período neonatal, y los recién nacidos afectados pueden ser remitidos para tratamientos como la cirugía de las cataratas, el glaucoma y el retinoblastoma (un tumor maligno), el seguimiento a largo plazo o la derivación a una evaluación general de la salud o la rehabilitación visual (113). La evaluación ocular del recién nacido generalmente se realiza con una linterna para examinar las estructuras externas del ojo y con pruebas de reflejo rojo, que requieren un oftalmoscopio directo o una alternativa adecuada.…”

“…La evidencia procedió de una revisión sistemática del tamizaje ocular universal de recién nacidos (113). En la revisión se encontraron 25 estudios no aleatorizados con un total de 2.289.431 recién nacidos, y tres de esos estudios se incluyeron en este resumen de la evidencia.…”

Newborn screening: a comprehensive approach to the diagnosis of hereditary and congenital diseases

“…Неонатальний офтальмологічний скринінг проводиться в першу добу після народження дитини, хоча може відтермінуватись на 1-3 дні за умови ускладнених пологів, у результаті яких у новонародженого можуть бути пошкоджені судини ока. Традиційний офтальмологічний скринінг новонароджених проводиться з використанням тесту червоного рефлексу [32]. Непряма (зворотна) офтальмоскопія дозволяє діагностувати вроджену катаракту, косоокість, тяжку далекозорість, анізоаметропію, аномалії сітківки (включаючи ретинобластому).…”

Delayed diagnosis of congenital cataract in preterm infants: Findings from the IoLunder2 cohort study

“…Thus, effective treatment requires prompt detection, which also allows prompt diagnosis of associated genetic or other non-ocular disorders. Consequently, universal screening programmes to detect congenital cataract exist in many countries [5][6][7]. In the United Kingdom (UK) the Newborn and Infant Physical Examination (NIPE) programme comprises clinical examination of the eyes by midwives or paediatricians in the first 72 hours of life alongside hips, heart and testes examination.…”

“…In the United Kingdom (UK) the Newborn and Infant Physical Examination (NIPE) programme comprises clinical examination of the eyes by midwives or paediatricians in the first 72 hours of life alongside hips, heart and testes examination. The eye testing comprises use of the direct ophthalmoscope to assess the red reflex, with congenital cataract as the target eye condition [5]. There is a 'safety net' examination in the community (family practitioners) at age six to eight weeks, coinciding with the first infant immunisations [5].…”