Oxygen and retrolental fibroplasia (Editorial)

Abstract

Retinopathy of prematurity, a disease entity initially referred to as retrolental fibroplasia (RLF), describes a disorder occurring in premature, low-birth-weight infants. In this condition, there is abnormal development of blood vessels in the retina. Initially, the abnormal vessels develop in the retinal periphery. In advanced stages, the retina may completely detach and form a fibrovascular mass behind the crystalline lens, thus the term retrolental fibroplasia. Terry first described RLF in 1942.1.Terry T.L Extreme prematurity and fibroblastic overgrowth of persistent vascular sheath behind each crystalline lens I. Preliminary report.Am J Ophthalmol. 1942; 25: 203-204Google Scholar In 1952, The Journal published an editorial entitled “Anoxia and retrolental fibroplasia.”2.Anoxia and retrolental fibroplasia.J Pediatr. 1952; 40 ([editorial]): 684-686Abstract Full Text PDF PubMed Scopus (1) Google Scholar It pointed out that two points on RLF stood out: (1) it occurred in the more immature of the premature infants; and (2) the increased incidence had taken place with improved pediatric techniques that had lowered the mortality rate of premature infants. The editorial reviewed the work of Dr Thaddeus Szewczyk, an ophthalmologist from East Saint Louis, Illinois, who followed premature infants admitted to the hospital for treatment. Szewczyk's data indicated a relationship between the development of RLF and high exposure to oxygen in an incubator or by withdrawing oxygen too rapidly.3.Szewczyk T.S Retrolental fibroplasia. Etiology and prophylaxis.Am J Ophthalmol. 1952; 35: 301-310PubMed Google Scholar In the January 1954 issue of The Journal, a second editorial on the topic of RLF stated “Rarely have we encountered an idea or suggestion of which pro and con sides were so violently taken.”4.Retrolental fibroplasia and oxygen.J Pediatr. 1954; 44 ([editorial]): 122-123Abstract Full Text PDF Scopus (1) Google Scholar The editorial reviewed various clinical and animal studies and concluded by stating, “There is a growing feeling that oxygen should not be given routinely to the premature infant but reserved for individualized cases of asphyxia, and further, it should be used in as low a concentration as possible and for as short a time as possible.” A third editorial on RLF that appeared in the April 1954 issue of The Journal reviewed additional clinical and experimental data.5.Oxygen and retrolental fibroplasia.J Pediatr. 1954; 44 ([editorial]): 488Abstract Full Text PDF Google Scholar The editorial also discusses statistics from the National Society for the Prevention of Blindness, which reported a 47 % increase in blindness in preschool children from 1943 until 1950, mostly due to RLF. The author concludes, “Evidence continues to accumulate that the oxygen concentration to which the small premature infant is exposed in the incubator is related to the development of retrolental fibroplasia.” In July 1954, a fourth editorial discusses various studies, including an epidemiologic survey of RLF in Maryland.6.Retrolental fibroplasia.J Pediatr. 1954; 45 ([editorial]): 123Google Scholar In this study, the various hospitals were graded as to quality, including resources such as incubators. The editor states that, “It was not surprising to learn the better the service the higher incidence of RLF.” Taken as a whole, the four editorials are fascinating in that they reveal the challenges the medical profession faces in recognizing the unintended consequences of new technology.