11.04 Retinopathy of Prematurity (ROP)

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Overview

  1. Disease of the eye of premature babies that received supplemental oxygen
  2. Most likely due to premature lungs

Nursing Points

General

  1. Believed to be caused by disorganized growth of blood vessels due to oxygen deprivation, that get replaced by scar tissue
  2. In premature babies the eyes are not developed fully at birth
  3. Screening will be complete by a qualified examiner to determine diagnosis
  4. A common risk factor is supplemental high concentrated oxygen given in NICU settings

Assessment

  1. Vitreous hemorrhage (blood in the space between the lens and retina)
  2. Red reflex (red reflection of light noted when assessing eyes with ophthalmoscope→ we want to see this
  3. Leukocoria→”white pupil”- (abnormal white reflection of the eye)

Therapeutic Management

  1. Restrict/monitor supplemental O2
  2. Specialist
  3. Treatment is surgical intervention

Nursing Concepts

  1. Sensory perception
  2. Oxygenation
  3. Human development

Patient Education

  1. Necessary follow up
  2. Surgical need
  3. Will need corrective lenses

Reference Links

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Video Transcript

In this lesson I will help explain retinopathy of prematurity and your role in providing care.

Alright so a few basic items. Retinopathy of prematurity is abbreviated to ROP. It is a disease of the eye where the retina can detach and cause blindness. It is going to occur in our premature babies and is likely because of their premature lungs and receiving supplemental oxygen. So why? It sounds a little contradictory right? A baby needs oxygen, but in this case too much can cause a problem. So when a baby is born premature they can create a disorganized vascularity to the eye. Now when babies have immature lungs they need oxygen, right? So babies are given supplemental oxygen because yes breathing and gas exchange is important but this oxygen in high concentrations can damage the new retinal capillaries that have developed. So the premature eye is already at risk with the vascular pattern and scar tissue and then you add supplemental oxygen and it can damage the capillaries more. So the eye becomes diseased and pulling occurs with the vascularity and scar tissue and causes the retina to detach.

Ok so I want to make sure you are still with me so let’s review the problem before we talk about what we will do. We have premature eyes. So now there is disorganized growth of blood vessels because of oxygen deprivation. We give oxygen because of the deprivation and this can harm the capillaries that are forming. Scar tissue develops and then pulling at the vessels occurs in the eye and bleeding into the eye and retina detachment can occur which means blind if we have no retina. My mom was a premature baby and that was 70 years ago and so not sure that she was given the oxygen piece but had premature eyes. She went through life and was playing flag football in her 20s and got knocked to the ground, hitting the back of her head and her retina detached. So she is blind on her left side and it is believed that it was a cause of her prematurity that just didn’t affect her until later in life. She has to see a specialist for her right eye and they are watching it and being very careful but they believe she might eventually lose that retina as well. Of course in her premature days things were very different. Now we have some idea of what is causing it so we can care for these little kiddos differently to try and protect them from ROP or be able to early intervene.

Our management is going to really involve monitoring the oxygenation. On a premature baby the monitors will be set to beep at us if the oxygen level gets above around 96%. That seems so weird, right? We are used to things beeping because we are getting too low. If a baby isn’t getting oxygen and is just 100% on their own we clearly aren’t going to be taking oxygen from that baby but if we can restrict oxygen for the premature babies that are receiving it then we will. So we want to ensure the baby is getting enough to oxygenate their bodies but not too much that it is going to increase the ROP risk. We will ensure a specialist sees these premature babies and that follow up is set up for after discharge. If a problem has occurred like a detached retina then our treatment is surgical intervention. Families need education on the need for follow up, surgical intervention if needed and that corrective lenses will probably be necessary.
The concepts involve sensory perception because it is vision, oxygenation because it is a cause, and human development because it is the development of the eye and how the vascularity form.

Ok let’s look at the important facts. With ROP you have a premature baby and vascularity that doesn’t develop correctly. This with extra oxygen can cause a vessels to be injured and bleeding into the eye to occur or the retina to detach. These babies need exams in the NICU, follow up, and surgery to correct.

Make sure you check out the resources attached to this lesson and review the key points. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 5

A newborn in the NICU with a diagnosis of retinopathy from a detached retina should be prepared for which intervention in the near future?

  • Question 2 of 5

A nurse is caring for a premature infant newly admitted to the NICU. Which order should the nurse question?

  • Question 3 of 5

An 31 week newborn is in the NICU receiving oxygen at 6 L/min. The SpO2 is continually reading 99-100%. What is a priority nursing intervention?

  • Question 4 of 5

A nurse is assessing a newborn for retinopathy of prematurity. The nurse knows that which of the following increase the risk for this disease? Select all that apply.

  • Question 5 of 5

What assessment finding would you expect on a child with a detached retina?

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