Ciao-Lin Ho

Background: Continuous bright light (CBL) and dim light (DL) exposure in premature babies may adversely affect their physiological and vision development and interfere with parental sleep and quality of life. Purpose: This systematic review and meta-analysis were conducted to investigate the effects of day/night cycled light (CL) exposure on weight gain and length of hospital stay (LOS) in premature infants. Methods: MEDLINE, PsycINFO, PubMed, CINAHL, Cochrane, Airiti Library, and Google Scholar were searched using appropriate keywords for relevant English or Chinese articles published before April 7, 2023. Study quality was evaluated using RevMan software (version 5.4) and the Cochrane risk-of-bias assessment tool (version 2.0). The cohort was divided into two groups based on the light exposure cycle studied, namely the intervention (CL) and control (CBL and DL) groups. Results: Ten studies were included in the meta-analysis, with the results revealing LOS was, respectively, 8.11 days (95% confidence interval [CI]=[−14.76, −1.46]; p=.02) and 7.21 days (95% CI=[−13.82, −0.60]; p=.03) less in the CL group than in the DL and CBL groups. Thus, the CL group recorded a total reduction of 7.52 days in LOS (95% CI=[−12.87, −2.17]; p=.006). Also, the standardized mean difference in weight gain between the CL and DL/CBL groups was 0.62 (95% CI=[0.00, 1.24]; p=.05). Conclusion/Implications for Practice: The findings indicate that premature infants exposed to CL experience substantially less LOS and more weight gain than their peers exposed to either DL or CBL. As premature infants require CL exposure after discharge, its implementation in the neonatal intensive care unit should be transitional and timed appropriately. Notably, the studies included in this meta-analysis used small sample sizes and were affected by a number of quality concerns. Thus, large-scale studies should be conducted to confirm the optimal duration of CL exposure for premature infants in neonatal intensive care units.

The use of atropine is currently one of the most effective methods used to prevent myopia progression. The purpose of this study was to investigate atropine adherence in preschool children with myopia, to explain the context of treatment through caregivers, and to identify barriers and facilitators of using atropine. We conducted in-depth interviews with 60 caregivers of children (parents, kindergarten teachers and nurses) in four different areas ranging from large cities to rural areas in Taiwan. Based on the social ecological theory model, the recorded text was systematically analyzed, extracted, edited and indexed by NVivo 12 Plus. After interviewing caregivers, we determined the barriers and facilitators at the four levels of influence (children, parents, school, and hospital and society). Barriers included the side effects, parental neglect, lack of understanding of long-term drug use, lack of conducive environment, and lack of friendly medical services. Facilitators included overcoming side effects, parental responsibility, myopia progression on treatment adherence, teacher support, management by nurses, navigation by ophthalmologists, and model learning. Hence, establishing a social support network, discussing the experience of individualized drug use in preschool children, and establishing a friendly medical intervention strategy can raise awareness among parents regarding myopia, and improve atropine adherence in preschool children.

Myopia in children has dramatically increased worldwide. A systematic review and meta-analysis were conducted to evaluate the effects of outdoor light exposure on myopia. According to research data from 13 studies of 15,081 children aged 4–14 at baseline, outdoor light exposure significantly reduced myopia incidence/prevalence (odds ratio [OR] = 0.85, 95% confidence interval [CI]: 0.80–0.91, p < 0.00001; I2 = 90%), spherical equivalent refractive error (SER) by 0.15 D/year (0.09–0.27, p < 0.0001), and axial elongation by 0.08 mm/year (−0.14 to −0.02, p = 0.02). The benefits of outdoor light exposure intervention, according to pooled overall results, included decreases in three myopia indicators: 50% in myopia incidence, 32.9% in SER, and 24.9% in axial elongation for individuals in Asia. Daily outdoor light exposure of more than 120 min was the most effective intervention, and weekly intervention time exhibited a dose–response relationship with all three indicators. Subgroup comparisons revealed that interventional studies report greater benefits from outdoor light exposure compared with cohort and cross-sectional studies, and individuals with myopia in intervention studies experienced slightly greater benefits than individuals without, in terms of SER and axial elongation. Therefore, this study suggests 120 min/day of outdoor light exposure at school.