as thologies INTRODUCTION pathway ofdiseasetreatment. Address forcorrespondence : Results. ophthalmologist inthematernalward,1to3daysafterbirth. Introduction. Abstract Conclusion. Caucasians andnon-Caucasians. thologies. requires Nord 140,65123Pescara, Italy. E-mail:[email protected]. Methods. an miss thologies the are during formed byapediatricianinall newbornsatbirth. diagnosed vention. sibly [5] nosed withinthefirstyearoflife. interventions or checking thataredreflexcomes backfrombotheyes. room, of weeks with Red into in The In In Italy by a age early provided majority Roberto Perilli screening better both 2008, Reflex both more 2012, at an of projecting in rapid a in birth, diagnosis. altered an Italianexperienceon5000healthy, Chan age pediatric an Among bilateral

(cataract eyes compared an only In The than by the a in Test early in postnatal early of our non-institutional Performing for the the would by from Visual American children 64% et al. unilateral most red congenital 2500 (RRT): hospital, disease the the a pediatricians ones. age diagnosis identification examination Families and reflex trained of approximately Roberto to [3] be first diffuse performance light births of the 1 increase Screening eyediseasesinbabies: , international ) Mandal an

undergoing Modesto Lanci reported this treatment Academy 6 cataracts an in 5000 all maternal of effective months, Perilli, pediatrician having and photographs, per early full-term, and must a survey later newborns direct with year, an of et al. of UOSD sight-threatening that in-hospital of and are 18 problems of be early visual and congenital wards, way and in guidelines surgery literature eyes the Pediatrics [6] 1 [4] inches ophthalmoscope (about UOSD OftalmologiaSocialeTerritoriale, AUSLPescara,Italy performed, visual often healthy before Oftalmologia the amblyopia treatment to in 80% RRT reported reported thus acuity examined, with and 2 infant’s miss 3 a , AntoninoRomanzo UOC Oculistica,OspedalePediatricoBambinoGesù,Rome,Italy diagnosed in away, outcomes thorough darkened 60%) before 10 are delaying was newborns congenital eye was in accessing on (AAP) none 4 weeks [1, UOC Neonatologia,Ospedale“SpiritoSanto”,Pescara,Italy diag- none Sociale pos- that pre- that and per and life, the pa- pa- are reported, 2 consecutive newborns 2] UOC Oculistica,Ospedale“SpiritoSanto”,Pescara,Italy a 6 and -

high eye amblyopia Territoriale, are health pathologies to (focusing thereafter arm’s MATERIALS ANDMETHODS therapeutic pathwayassoonpossible. prompt thalmologist, temic thalmologist. Allyn, drops gist pressing by borns’ is Santo” both 116 routine 1 to3daysafterbirth. casian: examination incidence thoroughly Since In In part start sex Ann IstSuperSanità2015|Vol. 51,No.4:387-389 with can males February this the services distance absorption. USA), (Visumidriatic of eyes and AUSL Hospital (lazy 2427 an clinical diagnosis June easily differences the anterior paper, an the adds early and 3 ethnicity) is of , LauraSabatini in institutional eye) Pescara, 2011, inner examined males checks in Pupils conditioned integrate risk with congenital 2014, (according a 123 ones a and all we in handful prevention. and segment closer to Then, plane) newborns lid at females; Pescara, a and DSB demonstrate effective between are the 5000 in delay 0.5%, the had allowing direct canthus the DOI: 10.4415/ANN_15_04_22 by all Pescara 2334 red dilated exam in and maternity pa- and of to received an by consecutive full-term, or RRT and a Visupharma, reflex see seconds, Italy, the ophthalmoscope darkened parent-approved females; posterior Nord, of the in the 4 with with Table 1 andPaolaFusilli • • • • • Key words AAP how the order the of ill newborn eyeexamination red reflextest congenital glaucoma congenital cataract congenital eyediseases the ward fundus Via healthy both babies an 0.5% anterior thus an eye newborns guidelines), Nazionale non-Caucasian: test room, for examination pole to of ophthalmolo- Italy), eyes examination tropicamide distribution of providing reduce the by to newborns, (focusing the the segment start series from an (Welch- “Spirito Adriatica gently (Cau- new- oph- oph- and sys- the an of of a 4

387 Brief notes 388 Roberto Perilli, Modesto Lanci, Antonino Romanzo et al.

Table 1 lar attention to other signs of local (glaucoma) and/or Sample distribution by ethnicity and sex systemic (neurofibromatosis or other neural crest cell Ethnicity Males Females Total (%) disorders) disease, always absent, and reported to the newborn’s pediatrician. Total sample 2547 2457 5000 (100) Retinal haemorrhages were found in 79 newborns, all Caucasian 2427 2334 4761 (95.2) of which born by vaginal delivery.

otes Non Caucasian 116 123 239 (4.8) DISCUSSION

N African 79 85 164(3.3) Tropicamide 0.5% confirmed being a safe drug [7]. Chinese 23 17 40 (0.8) International literature reports a wide range of inci- rief Hispanic 14 19 33 (0.7)

B dence as for congenital pathologies: congenital cata- Indian 0 2 2 (0.04) ract: 0.1-1.5/1000 in general [8], 0.3/1000 (2 out of 3 bilateral) in the United Kingdom [9]; congenital glau- coma: 0.1/1000 in developed countries, 0.8/1000 in Slo- vakian Roms, 0.4/1000 in the Middle East, 0.31/1000 the retina), at a few centimeters’ distance. Moreover, in Andhra Pradesh, India [10]; of the iris he disposes of a ruler, to measure the corneal diameters and retina: 0.48/1000 in Minnesota, USA, 0.037/1000 in the suspect of buphthalmos in congenital glaucoma. in Hungary and 0.08/1000 in Scotland [11]. Retinal Tests are routinely performed with the parents’ in- haemorrhages involving the macula can interfere with formed consent and data treated in compliance with the natural development of visual function in the first the Declaration of Helsinki. The present note is a re- days or weeks [12]. port of routine clinical practice. All pathologic infants In our series, the incidence of pathologies ranks high are sent to the Bambino Gesù Children Hospital in in worldwide reports, possibly because all newborns Rome, for therapy and for a thorough study of both the were screened, thus avoiding missing cases. newborns’ clinical condition and the parents’ health With limitations owing to the small sample, there status. was a significant difference between Caucasian and non-Caucasian newborns: cataract’s incidence was RESULTS 1.05/1000 in Caucasians and 8.37/1000 in non-Cauca- No newborn suffered from adverse effects to tropi- sians (p = < 0.005); glaucoma’s incidence was 0.21/1000 camide. Pathologies are summarized in Table 2. Cata- in Caucasians and 8.37/1000 in non-Caucasians (p = < racts (n = 7) were both bilateral and involving the visual 0.001). axis (n = 4), or unilateral and sparing the visual axis (n = 3). Glaucomas (n = 3) were all bilateral. CONCLUSIONS In addition, one case of Primary Hyperplastic Vitre- We believe that our results raise important problems ous Persistence (PHVP), one case of angle dysgenesis of health policy: missing the opportunity of a thorough and one case of inferior coloboma of the iris, retina and eye exam or − at least − a RRT at birth, particularly in choroid were reported. babies who may have a delayed and/or difficult approach Embryonic vitreous remnants were frequent: pupil- to (public) assistance, increases the risk of not having lary strands (n = 679) and/or (multi)focal their pathologies identified and treated in due time. This uveae (n = 128, mainly in the superior pupillary mar- appears to be important particularly for non-Caucasian gin). Cases with ectropion uveae were given particu- babies, showing a higher incidence of pathologies.

Table 2 Sample distribution by ethnicity, sex and pathology Type of pathology n Male incidence n Female incidence n Total incidence (%) (%) (%) Cataract in Caucasians 2 0.82 3 1.29 5 1.05 Cataract in non Caucasians 0 0 2 16.26 2 8.37 Glaucoma in Caucasians 0 0 1 0.43 1 0.21 Glaucoma in non Caucasians 0 0 2 16.26 2 8.37 PHVP ^* 0 0 1 0.41 1 0.20 Angle dysgenesis* 0 0 1 0.41 1 0.20 Coloboma* 0 0 1 0.41 1 0.20 Pupillary strands* 367 144.32 312 126.98 679 135.80 Ectropion uveae* 96 37.75 32 13.02 128 25.60 Retinal haemorrhages* 42 16.52 37 15.06 79 15.80 ^PHVP: primary hyperplastic vitreous persistence; *Incidence ‰ is calculated on the whole sample of 5000 newborns (2543 males and 2457 females) independently from ethnicity. 389 Neonatal eye screening

Aside of genetic factors, it is well known [13, 14] that pathologies, shows how late intrauterine processes can a series of social ones is related to health (mainly infec- continue even after birth (what has been pathologically tious diseases) and mortality: income, education, occu- shown by the case of PHVP). pation, marital status and so on. Moreover, in different In our experience, the RRT can be easily integrated ethnicities the prevalence of both systemic and ocular with a thorough eye examination and performed at the diseases (infectious and non-infectious) is heteroge- maternity ward by an ophthalmologist in a very short

neous, and the immunization status can be suboptimal time, thus possibly widening the spectrum of clinical otes [15]: this could account for subclinical or latent condi- conditions being detected. In Italy, the eye examination tions predisposing to a pathologic development of eye at birth is not always provided as a routine procedure N structures. in hospital settings, but we believe it should be encour- Finally, from a strictly scientific viewpoint, it is very aged, since it fulfills both the 1968 Wilson and Jungner’s rief B interesting to notice how a careful and close examina- [17] and the 2008 World Health Organization’s [18] tion of structures like the iris and pupil (missed by the criteria for screenings. RRT) can show aspects of late intrauterine development of the eye: such structures are involved in the regression Conflict of interest statement of the tunica vasculosa lentis (a membrane covering the None of the authors has any kind of conflict of inter- and extending across the pupil, regressing before est. birth) [16]: the high incidence of pupillary strands and (multi)focal ectropion uveae, disappearing in the weeks/ Received on 1 April 2015. months after birth and never related to eye or systemic Accepted on 17 September 2015.

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