Remarks

• Universal newborn screening for abnormalities of the eye should be done prior to discharge after a health-facility birth or at the first postnatal care contact in an outpatient setting after a home birth. Ideally, the screening should be done within the first six weeks after birth.
• An external examination of the eye and red reflex test should be done using standard equipment (e.g. a direct ophthalmoscope) by a trained health worker.
• The Guideline Development Group (GDG) acknowledged the evidence reviewed related to screening for a single condition (congenital cataract). However, since the red reflex test can detect a wide range of conditions, the GDG expanded the recommendation to cover all abnormalities of the eye that may be detected on a screening examination.
• The recommendation is based on evidence from studies in all newborns, irrespective of gestation or presence/absence of high-risk factors. However, evidence from studies conducted only in high-risk populations such as preterm newborns or those with congenital anomalies was not considered.
• The extension of the recommendation to include diagnostics and management was made to incorporate the principles of screening (87).
• Systems for screening, referral, diagnosis and management should be established or strengthened to ensure adequate follow-up and management for those who screen positive.