NICU and beyond: Eyecare for the infant, Part 1

Two patients in one week referred by a young neonatologist? I was truly impressed. Most of the times the care offered by a neonatologist ends when the child is shifted out of the NICU. The care of the patient is then taken over by the pediatrician who follows the child through infancy and beyond. Let me tell you some more about these two infants.

I saw Baby of Shivani (the baby had not yet had a naming ceremony), a cute four-month-old baby boy who had been delivered by an emergency Cesarian section. He was born full term, and the mother had been in labor for 6 hours when the obstetrician had noticed the child’s heart rate dropping (bradycardia). She had proceeded to perform an emergency Cesarian section as she suspected the child may have the umbilical cord wrapped around his neck. The baby had come out looking a bit blue in color and did not cry immediately. He was quickly resuscitated and shifted to the NICU. He received supportive care for five days and eventually discharged home with the mother when stable.

The neonatologist Dr. Minu had written in bold letters in the discharge summary that the child needed an eye exam in three months. The family had contacted their ophthalmologist to whom they go for spectacles. He was unclear as to why Dr. Minu had asked for an eye exam and reassured them that it was not necessary. The father of the baby who was not satisfied contacted the neonatologist who impressed upon them that they needed to see a pediatric ophthalmologist and that is how they ended up in my clinic. The baby had just woken up and was playful. I noticed that while he was making cooing sounds his eye contact and social smile were inadequate.

I did a complete eye examination and found that he had moderate hypermetropia (plus power). The rest of the eye test was normal. I suspected that the child may have some cerebral visual impairment (CVI) due to delayed cry and lack of oxygen at birth which may have affected the portions of brain responsible for vision. These children may have poor focusing ability for faces. Often an MRI is needed to confirm the diagnosis but honestly, we could do it when the child is a bit older. It is more important to recognize the risk factors for CVI and start intervention without delay.

The family ordered the spectacles right away and brought them to the clinic the following week. That day as well, the baby was awake and playful. I slipped the glasses on to his small face and watched as his face transformed. He broke into a smile upon seeing his mother’s smiling face and gazed at her wide-eyed.

The family was happy and so was I. I mentally thanked the young neonatologist who had insisted that this child who had difficulty with breathing at birth should be seen by a pediatric ophthalmologist.

Are you wondering who was the other baby? That story in my next blog.