Special report: Retrolental Fibroplasia Correction
Dr. Philip James As with some of the physicians on this list I was at medical school just after the role of oxygen in producing blindness in premature neonates in the 1950s had been fully established and hammered home in teaching. After nearly 40 years I now know that IT IS WRONG. Yesterday I was astounded to find these details in a letter from RM Forrester:- Szewczyk first suggested that retrolental fibroplasia was produced by habituating a child to an enriched oxygen atmosphere and by too sudden withdrawal. If Szewczyk's theory was correct the disease in the early stage should appear after the child's removal from a high oxygen environment; this is, almost without exception, true.
The next logical step was to say that if the retinopathy developed when the child came out of oxygen the safest thing to do would be to put him back in again. We used this technique in 17 cases. The results were SPECTACULAR; in each individual case the retinal vascular pattern, having shown gross abnormalities, returned to normal. In most cases a slow reduction of oxygen and final return to atmospheric concentration over a period of weeks was all that was necessary, but two infants needed a third period of oxygen exposure because the disease again became active. Many of the infants were exposed to high oxygen tensions for very long periods (the longest were 93, 88, 85 and 83 days) Twelve of these 17 infants recovered with normal eyes and five had minor permanent changes not causing blindness. If one believes that oxygen has a direct toxic effect on the infant's retina these surely would have been the infants who became blind for they were all of very low birth weight, all had the early retinopathy and they were all subjected to intensive and prolonged therapy.
Forrester RM Letter to the editor Dev Med Child Neurol 1964;6:648-650 Alison McDonald had already made the point that oxygen protects against cerebral palsy 1 of 16 children born in 1950 to 1952 had cerebral palsy and 4 had retrolental fibroplasia 10 of 25 born in 1953-1955 had cerebral palsy and None had retrolental fibroplasia (p<0.02) Significance for increase in CP without additional oxygen (p< 0.05) Significance of reduction of retrolental fibroplasia without additional oxygen (p<0.02) Alison D McDonald Dev Med Child Neurol 1964;6:313-314. Hundreds of thousands of children have died or consigned to a lifetime of disability simply because we have neglected to use oxygen properly. We have a duty to see that this terrible mistake is corrected Philip James, Wolfson Hyperbaric Medicine Unit, University of Dundee
Reprinted with Permission
