Transcript of the TV discussion about
Blinding premature babies by excess nursery lighting
on "Good Morning, America" between
H. Peter Aleff, father of a victim, and
Dr. Gerald B. Merenstein,
Chairman of the Committee on Fetus and Newborn of the
American Academy of Pediatrics, Professor of Pediatrics and Acting
Chairman of the Department of Pediatrics at the University of Colorado in Denver.
Charles Gibson moderated as host, and the segment aired on August 30, 1989.
Click here to view the video in
Windows Media Player, as well as those transcribed on the next two pages.
Charles Gibson: Over 3,000 premature babies a year are seriously handicapped by an eye disease called retinopathy of prematurity. More than 500 of those infants suffer total blindness. Although medical researchers have not reached a definitive conclusion as to the disease's cause, the father of one of its victims has come up with a controversial theory. He says the blindness is caused by the bright lights used in the intensive care wards in which the premature infants are treated after birth.
Peter Aleff is that father, and he is joining us here in New York this morning. Also joining us from Denver is Dr. Gerald Merenstein. He is the Chairman of the Committee on Fetus and Newborn of the American Academy of Pediatrics and Professor and Acting Chairman of the Department of Pediatrics at the University of Colorado.
Good morning to both of you. Peter, let me start with you. You had a son born at 24 weeks - right? And you as a layman got into studying what might have been the cause.
Peter Aleff: Right.
Charles Gibson: And what led you to conclude that it was the lighting in the pediatrics ward?
Peter Aleff: A year after his birth, I was running a factory where we were curing inks and paints with ultraviolet light, and I studied the occupational safety aspects of the lighting at the time to make sure that everything was OK for the workers. At that time I discovered that the same problem applied also to the blue light emitted by the fluorescent lamps in the intensive care nurseries and that the eye damage there would be the same as to the workers.
Then I took some time off and studied this more in the medical libraries and found out that this damage is actually more likely to do damage to the premature babies than to adults who are much more resistant against this light damage.
Charles Gibson: Why do you think it's that? And not just the fact that the babies are born very prematurely and thus don't have fully developed eyes?
Peter Aleff: Well, to simply blame prematurity alone would be like blaming gravity for airplane crashes. It is one of the reasons, but it is certainly not sufficient.
Charles Gibson: Alright, let me turn to Dr. Merenstein. Your reaction to that theory. Dr. Merenstein?
The thought that light might be involved in retinopathy of prematurity is not a
new one. There was an epidemic in the late 40s and early 50s that many many
different theories, including the light, were postulated for.
Charles Gibson: But as I understand it, fluorescent lights were introduced at about that point, were they not? Just before that epidemic?
Dr. Merenstein: Right, and they were studied in several studies then that showed no correlation, and a study just published in June of this year again looked at it and could find no direct cause. I think Mr. Aleff is right - there is work in animals ex- posed in different situations than babies would be. There has been one study that has raised the suggestion and it needs to be studied and looked at, and it is my understanding that the National Eye Institute is planning a multi-center study to look at it.
Charles Gibson (to Peter Aleff): I gather that that's a reaction you get from most people when you take this problem to them - that it needs further study?
Peter Aleff: Yes, that more research is needed. But in fact, the studies that Dr. Merenstein is referring to and that supposedly prove the lights were safe all suffered from the same basic flaw: that the babies were protected only after the first day of their life, while it is sufficient to expose them to the lights for less than three hours to already give them more than 19 times the dose of light that is considered as the danger limit for industrial workers.
Charles Gibson: For the moment accepting your theory -- what would you have hospitals do? Turn down the lights? Get rid of fluorescent lights?
Peter Aleff: Replace fluorescent lights with incandescent light.
Charles Gibson: Right -- and turn them down?
Peter Aleff: Yes, whenever there is no need for bright lighting to do an examination, then turn them down with a dimmer switch.
Charles Gibson: Alright, Dr. Merenstein, accepting your postulation for a moment that further study is needed - what would be wrong with getting rid of fluorescent lights, using incandescent lights, and turning them down most of the time in wards where premature babies are kept?
Dr. Merenstein: Anytime we do anything different in the nursery we have to be very careful. The first epidemic we had of retinopathy taught us some lessons, and that was that oxygen which was intro- duced because it made babies breathe more easily. That led to the epidemic of retinopathy.
When it was discovered that at that time oxygen was the primary cause of that epidemic people quickly turned down the oxygen, and we went through another epidemic of increased deaths and babies who were brain damaged. Premature babies are very very complex, and simple changes should not be introduced without studying them very carefully.
Even something as simple as keeping the lights very low may have an adverse effect that we are not aware of.
And so that retinopathy, although Mr. Aleff is right there may be some effect from light, it certainly is not the cause of it, and we need to be careful of how we implement any new change in nurseries with these very small and very fragile in- fants.
Charles Gibson: Well, very interesting problem. I am sure there will be more study, and Mr. Aleff, I gather your campaign to get hospitals to get rid of fluorescent lights will continue.
Peter Aleff: Yes, particularly since I do not understand why Dr. Merensstein feels there is a great need for study for switching off the lights when there was no study whatsoever for putting the lights in there in the first place.
Charles' Gibson: We will leave it at that point. Peter Aleff, Dr. Merenstein, thank you for being with us this morning.
Unfortunately, the transcript cannot show Dr. Merenstein's high blink rate during his above statements. However, when you compare his defense of the status quo on TV with some his own writings that contradict everything he said there, you get a measure of his obvious discomfort in so belittling and denying the dangers from excess light:
On TV, when questioned about the reason for exposing the retinae of premature babies to many times the adult danger level dose for such damaging irradiation, he said:
"Even something as simple as keeping the lights very low may have an adverse effect that we are not aware of." ("Good Morning America", August 30, 1989).
However, in the "Handbook of Neonatal Intensive Care" published also in 1989 by the C.V. Mosby Company and co-authored by this same Dr. Merenstein, he and his co-author say:
"Newborns are sensitive to bright light and will tightly close their eyes in its presence."
(page 638 right, near bottom)
"The fetus is able to distinguish light from dark and recoils from a bright light shone at the mother's abdomen."
(page 640 left, top)
(Neonatal Intensive Care Unit) is also an environment of sensory bombardment -- constant noise, light, (...) upset of sleep-wake cycles (...) etc. (...) Since the immature Central Nervous System of the premature infant is unable to tolerate these stimuli, the easily overstimulated preterm infant protects himself or herself by physiologic and interactional defensive maneuvers that
threaten survival and social ability and may lead to
(page 645 right, top and middle)
"In utero, the states of the fetus are regulated by the sleep-wake cycles of the mother. In the NICU multiple intrusions disrupt regulation: how this impacts on the infant is not fully known, although limited energy may be drained and the infant subjected to further stress. (... ) Day-night cycles are facilitated by afternoon nap time and nighttime in which the dimming of lights or covering of incubators and cribs with blankets and quieting of NICU noise enables babies to sleep. Deep, quiet sleep is facilitated by quiet and dark."
(page 650 left, top and bottom)
"The NICU is lit with bright cool-white fluorescent lights 24 hours a day to enable immediate and ongoing visibility of all infants. Although there is no neonatal research on the hazards of this type of lighting
[Note: this was not true when printed, see Glass et al. in NEJM August 15, 1985], there is
abundant animal, child, and adult research documenting
negative biochemical and physical effects (change in endocrine function, increased hypocalcemia, cell transformations, immature gonadal development, and chromosome breakage).
The first goal in visual intervention is to assess the current level of light and decrease it wherever possible. The very immature preterm infant is accustomed to the muted light of the uterus -- light filtered through the abdominal and uterine walls -- and has fused (if less than 26 weeks gestation) eyelids.
Draping blankets on top of the incubator decreases the light at the infant's level but allows immediate maximal illumination when the blanket is pulled back. Since babies are continuously monitored, not all babies need to be maximally illuminated at all times. (...) Visual stimulation is very tiring and taxing (increases the heart rate) to the immature baby."
(page 657, left bottom and right, top to middle)
Those quotes are all from Dr. Merenstein's book. Yet, in his professional judgment as Committee Chairman at the American Academy of Pediatrics, these highly harmful, well documented, and very real dangers from indiscriminate irradiation which he described in his book are suddenly outweighed by some unknown and undefined, otherwise unheard-of but allegedly potential dangers of withholding bright light from premature babies who by definition still belong in a dark womb.
No wonder this distinguished doctor had to blink so much while contradicting himself so blatantly to offer this irrational and indefensible defense of the current malpractice in his profession.