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Visual function in term infants with hypoxic-ischaemic insults: correlation with neurodevelopment at 2 years of age
E Mercuri1, L Haataja, A Guzzetta
1Visual Development Unit, University College, London.
Insights
Early visual assessments in infants experiencing hypoxic-ischaemic insults can predict neurodevelopmental outcomes. Abnormalities in visual tests at 5 months correlate with poorer development at 2 years, aiding in prognosis.
Area of Science:
- Neonatal neurology
- Developmental pediatrics
- Ophthalmology
Background:
- Hypoxic-ischaemic insults can lead to significant neurodevelopmental challenges in term infants.
- Early detection of potential developmental issues is crucial for timely intervention.
Purpose of the Study:
- To investigate the association between visual assessment findings at 5 months of age and neurodevelopmental outcomes at 2 years in infants with hypoxic-ischaemic insults.
- To evaluate the prognostic value of specific visual tests in this population.
Main Methods:
- Prospective evaluation of 29 term infants with hypoxic-ischaemic encephalopathy or neonatal brain lesions.
- Visual function assessment at 5 months using the Atkinson Battery, including optokinetic nystagmus (OKN), acuity, visual fields, fixation shift, and visual evoked potentials.
- Structured neurological evaluation and Griffiths developmental assessment at 2 years.
Main Results:
- A strong correlation was observed between the extent of early visual impairment and neurodevelopmental outcomes (neuromotor and global).
- Infants with more than three abnormal visual tests at 5 months were more likely to have abnormal neurological and developmental assessments at 2 years.
- Even in children with fewer abnormalities, the number of passed visual tests related to their developmental performance.
Conclusions:
- Individual visual tests offer valuable prognostic information for neurodevelopmental outcomes.
- Abnormal optokinetic nystagmus (OKN) and acuity strongly predicted adverse outcomes.
- Normal visual evoked potentials and fixation shift results were associated with normal neurodevelopmental outcomes.
Aims:
To determine if there is any association between the findings of visual assessment performed at the age of 5 months and neurodevelopmental outcome at the age of 2 years in children who have sustained hypoxic-ischaemic insults.
Methods:
Twenty nine term infants with hypoxic-ischaemic encephalopathy and/or brain lesions on neonatal magnetic resonance imaging (MRI) were prospectively evaluated. At 5 months of age all the infants had their visual function assessed using the Atkinson Battery of Child Development for Examining Functional Vision, which includes the assessments of optokinetic nystagmus (OKN), acuity, visual fields, fixation shift and phase and orientation reversal visual evoked potentials. At 2 years of age the children had a structured neurological evaluation and a Griffiths developmental assessment.
Results:
There was good correlation between the extent of the early detected visual impairment and both neuromotor and global development. Children with more than three out of five abnormal visual tests at 5 months of age tended to have abnormal neurological examination results and abnormal developmental quotients. Children with three or fewer abnormalities tended to have developmental quotients in the normal range; the level of their performance, however, was still related to the number of visual tests passed.
Conclusions:
Individual visual tests can provide important prognostic information. While abnormal OKN and acuity were always associated with abnormal outcome, normal results on visual evoked potentials and fixation shift tended to be associated with normal outcome.