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Reduced visual resolution acuity and cerebral white matter damage in very-low-birthweight infants
J P SanGiovanni1, E N Allred, D L Mayer
1National Eye Institute, Division of Epidemiology and Clinical Research, National Institutes of Health Building, Bethesda, MD 20892-2510, USA. jpsangio@nei.nih.gov
Insights
Neonatal cerebral white matter echolucencies are linked to vision problems in very-low-birthweight infants. This study confirms that white matter damage is a key factor in reduced visual acuity for these vulnerable infants.
Area of Science:
- Neonatal Neurology
- Ophthalmology
- Developmental Pediatrics
Background:
- Neonatal cerebral white matter echolucencies are associated with visual deficits in very-low-birthweight (VLBW) infants.
- The underlying factors contributing to this association require further investigation.
Purpose of the Study:
- To determine if maternal, intrapartum, infant, or ocular factors explain the link between white matter echolucencies and visual acuity deficits in VLBW infants.
- To confirm echolucency as a predictor of visual resolution acuity in VLBW infants.
Main Methods:
- Cranial ultrasound scans identified echolucency in VLBW infants.
- Visual resolution acuity was assessed using the Acuity Card Procedure (ACP).
- Logistic regression models analyzed the association between echolucency and visual acuity, adjusting for covariates.
Main Results:
- Echolucency consistently predicted abnormal visual resolution acuity across pre-, peri-, and postnatal developmental periods.
- Odds ratios for abnormal visual acuity ranged from 10.4 to 19.3 (p<0.03).
- No significant confounding factors were identified to fully account for the association.
Conclusions:
- Cerebral white matter damage, indicated by echolucencies, is a significant predictor of reduced visual resolution acuity in VLBW infants.
- This finding highlights the importance of monitoring visual development in VLBW infants with evidence of white matter abnormalities.
Abstract:
Neonatal cerebral white matter echolucencies predict visual resolution acuity deficits in very-low-birthweight (VLBW) infants. We examined maternal sociodemographic, lifestyle, intrapartum, infant birth/perinatal, and ocular motor/refractive characteristics to determine whether they accounted for this association in infants who were tested once between postnatal age 25 and 56 weeks (corrected for gestational age at birth). Cranial ultrasound scans were read by consensus to identify echolucency in a population of VLBW infants with no known ocular abnormalities. Visual resolution acuity was measured with the Acuity Card Procedure (ACP) in 14 infants with echolucency and compared with that of 81 VLBW infants born in the same hospitals with normal ultrasound scans. In time-oriented logistic regression models, echolucency remained a consistent predictor of abnormal visual resolution acuity after adjustment for covariates in three developmental periods (pre-, peri-, and postnatal). Odds ratios ranged from 19.3 (95% confidence interval, 4.5 to 82.2; p=0.001) to 10.4 (95% confidence interval, 1.3 to 81.9; p=0.03). Reduced visual resolution acuity in VLBW infants appears to be due to cerebral white matter damage.
