Baby-blinding retinopathy of prematurity and intensive care nursery lighting
by H. Peter Aleff
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To settle the conflict between the differing study results, a large multi-center trial is being planned. According to an August 1989 news report,
"two Dallas based ophthalmologists are now laying the plans for (a study of nursery lighting and ROP). In a prospectus recently submitted to the National Eye Institute, Drs. Rand Spencer and George Sanborn propose having 23 clinics assign preemies randomly to three treatment groups. Some kids would wear eyepatches or shaded goggles around-the-clock, some would wear them only at night, and some would go unprotected. By tracking the three groups simultaneously, and plotting ROP rates against actual exposure, the researchers would be able to rule with some coincidence on the presence of a hazard" (124).
The National Eye Institute has denied requests for information about the study plans under the Freedom of Information Act because "it is the policy of the Department of Health and Human Services not to disclose information relating to grant applications that have not been funded".
If such a study were undertaken, it would raise serious ethical issues. To enroll any preemies in the Spencer-Sanborn study, those involved with it may have to contravene informed consent.
According to Black's Law Dictionary, informed consent "is based on a full disclosure of facts to make the decision intelligently, i.e. knowledge of risks involved" (125). To comply with the law, the physicians would have to tell the parents about all the known and suspected dangers from the light exposure they propose for their baby. They cannot balance the risks with any alleged benefit from that proposed exposure.
Terry had suggested in 1945 a better testing method than keeping the preemies in a permabright environment and relying on eye patches:
"Precocious light exposure as a possible cause can be determined most effectively if a fairly safe technic is worked out which will permit keeping the infants in the dark, or perhaps under a red light, and adequately covering the eyes while the infants are being examined or given nursing care under normal lighting conditions" (38).
In contrast to Terry's concern that even a short exposure to the unaccustomed light might harm frail preemies, the Spencer- Sanbom study plan as reported, does not appear to consider the speed with which light can damage immature eyes. Without an understanding that minutes can count, the eyepatches may again be applied too late to make any difference, or the babies may struggle them off too often.
(Addendum in 2002: This study was actually performed from 1995 to 1998. See the series here on Research Frauds for a discussion of the many ethics violations and scientific fraud in that study. In the series LIGHT-ROP Manual you find these violations and frauds documented in the study authors' own words, obtained thanks to the Freedom of Information Act. The Bogus Bioethics and Sovereign Doctors series show you further that the US Government watchdog agencies alleged to protect patients and the public from such abuses covered them up instead.)
Bright nursery lighting
offers no benefit for the babies
While clinical studies document that myriad sacrificed animals and human preemies have suffered severe eye damage from fluorescent light, the intensive care nurseries are ablaze with fluorescent light.
Many neonatologists assert that the bright light is necessary so that they and the nurses can observe subtle color changes in the skin of the preemies. Skin color is supposed to be a diagnostic sign for a baby's degree of jaundice and for detecting low oxygen level.
Yet, the Merck Manual says in this context that "skin color should not be trusted to evaluate the severity of jaundice" (126), and the Guidelines for Perinatal Care, issued jointly by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, state specifically in the chapter on "Clinical Considerations in the Use of Oxygen" that "skin color cannot be used to estimate (blood oxygen) levels reliably" (127).
Furthermore, even if subtle skin color changes were a guide to a baby's need for oxygen, the nurse would be unlikely to see them in time to help the baby, as each preemie cannot be individually observed without interruption.
The "watch for color chances" rationale for the bright nursery lighting creates a vicious circle. The bright light damages the eyes. The doctors blame the eye damage on excess oxygen, so they reduce oxygen to the point where the baby is kept right at the edge of turning dusky or blue from lack of oxygen. The nurse is supposed to watch for these color changes and then give the baby temporarily a little more oxygen, just enough to prevent asphyxiation. To see these color changes, the nurse is said to need lots of light. That light damages the eyes of the babies. And so on.
Meanwhile, the excessive light continues to burn the retinae of many preemies, and the unnecessary oxygen rationing policies deprive many babies of the oxygen that would help them escape cerebral palsy and other brain damage, or even death. Much suffering and many deaths of preemies could be prevented by the flick of a light switch and the turn of an oxygen faucet.
Conclusions and recommendations
Based upon data collected by many researchers it may be concluded that fluorescent lighting in intensive care nurseries constitutes a hostile environment and merits immediate correction. Each year, thousands of premature babies lose their sight to retinopathy of prematurity as the result of being exposed to the light from fluorescent lamps. Light radiations in the violet and blue color bands are the causative agents of this blinding.
To prevent retinopathy of prematurity, the following recommendations are made:
1. All fluorescent lamps in intensive care nurseries in hospitals should be immediately removed and replaced with lamps using only incandescent light bulbs at intensities as low as possible and only when needed.
2. Bilirubin phototherapy lamps should be equipped with side shields to prevent their light from reaching neighboring babies; the eyes of the babies being treated with regular, predominantly blue fluorescent light must be kept securely patched. Green phototherapy lamps from which all wavelengths below 500 nm are filtered out would be preferable because they show a satisfactory clinical effect in degrading bilirubin and are much safer for the retina of the patients and their isolette-neighbors. Furthermore, they cause none of the chromosome damage associated with blue light (128). These phototherapy lamps should be at right angles to the babies so that the babies' heads are farther away from the cathodes at the end of the lamp tubes. These cathodes are surrounded by potentially harmful electromagnetic fields (129) and may emit low-intensity X-rays (130).
3. Most of the clinical literature on the role of oxygen in ROP treats supplementary oxygen as the cause of ROP, but this literature is incorrect and misleading. There was total absence of ROP before the advent of fluorescent light while many preemies had been receiving oxygen therapy for up to 6 weeks, and in concentrations of 40 to 55% (131). Until the early 1950s, when "liberal" oxygen supplementation was slandered (132), physicians and nurses credited oxygen with having saved many preemie lives (133). Oxygen could and should again play this central role in today's intensive care nurseries. There is no scientifically defensible reason for withholding its appropriate use from preemies.
Addendum about the alleged need for fluorescent lighting in intensive care nurseries, quoted from a letter Helen Harrison sent me on August 21, 1997:
"I also wanted to tell you about an interesting conversation I had with a nurse, Gay Gale, of Alta Bates Hospital, Berkeley, and Children's Hospital Oakland. She told me that a few years ago at Children's Hospital, Oakland, several nurses and doctors decided to change one room in the nursery to incandescent lighting, to see if it made a difference in caregiving observations or in environmental enhancement (being ignorant of the harm from fluorescent light, they weren't looking at ROP or visual outcomes).
No one who didn't already know the lights had been changed noticed or mentioned any difference. Those who did know the lights had been changed felt the incandescent room was cozier and warmer. The world didn't come to an end, caregiving proceeded without problems.
If only the Light-ROP researchers had simply changed the bulbs!
Gay Gale added the following comments when Helen Harrison asked her in June 2002 for permission to let me quote her here:
"The 'experiment' with the incandescent lights was in 1990. If you remember, ICN rooms D and E (on the fourth floor of CHO) are mirror opposites across a small hallway from each other. We changed to the incandescent bulbs in room D, and room E had the fluorescents.
As you say in your anecdote, the difference was too subtle to notice unless you were looking for it. The incandescent bulbs cast a softer, slightly pinker light which the staff found pleasing when they observed the difference."