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Ocular outcomes in low birth weight premature infants with intraventricular hemorrhage
Stephen P Christiansen1, Katherine J Fray, Trey Spencer
1Jones Eye Institute, Department of Ophthalmology, Arkansas Children's Hospital, Little Rock, USA.
Insights
High-grade intraventricular hemorrhage in premature infants significantly increases the risk of serious ocular complications, including strabismus and retinopathy of prematurity. Close ophthalmologic surveillance is crucial for these vulnerable infants.
Area of Science:
- Ophthalmology
- Neonatology
- Perinatology
Background:
- Premature infants, particularly those with very low birth weight (VLBW), face numerous health challenges.
- Intraventricular hemorrhage (IVH) is a common complication in VBW infants, with varying grades of severity.
- Ocular complications can significantly impact the long-term visual development of these infants.
Purpose of the Study:
- To investigate the association between intraventricular hemorrhage (IVH) and ocular outcomes in very low birth weight (VLBW) premature infants.
- To compare ocular findings in VLBW infants with high-grade IVH versus those with no or low-grade IVH.
- To emphasize the need for ophthalmologic surveillance in VLBW infants with IVH.
Main Methods:
- A cross-sectional study involving 60 VLBW premature infants (birth weight <1500 g) examined at 12 months corrected gestational age.
- Ophthalmologic examinations were conducted masked to the infants' medical history.
- Medical records were reviewed to document the occurrence and grade of IVH and other perinatal comorbidities.
Main Results:
- 17% of infants had neonatal IVH, with 18% experiencing high-grade IVH (grades III-IV).
- High-grade IVH was significantly associated with strabismus (73% vs 14%), ocular motility defects, nystagmus, optic nerve atrophy, and abnormal retinal findings.
- Infants with high-grade IVH had a higher likelihood of stage 3 or worse retinopathy of prematurity.
Conclusions:
- High-grade IVH in the early postnatal period is a significant risk factor for adverse ocular outcomes in VLBW infants.
- These findings underscore the importance of regular ophthalmologic monitoring for VLBW infants diagnosed with IVH.
- Early detection and management of ocular complications can potentially improve visual prognosis.
Purpose:
To study ocular outcomes in very low birth weight premature infants with intraventricular hemorrhage.
Methods:
Parents of 490 consecutive very low birth weight (less than 1500 g) premature infants who were discharged from the neonatal intensive care unit of our hospital between 1994 and 1996 were asked to enroll their child/children in this cross-sectional study. Sixty infants (12%) were recruited and had complete masked ophthalmologic examinations at 12 months corrected gestational age. The medical records of each infant were reviewed after the eye examination was complete. The occurrence of intraventricular hemorrhage and other perinatal comorbidities was documented. Ocular outcomes of infants with no or low-grade (grades I-II) hemorrhages were compared with those of infants with high-grade (grades III-IV) intraventricular hemorrhage.
Results:
Of the 60 infants examined, 17 (28%) had neonatal intraventricular hemorrhage. Eleven (18%) had high-grade intraventricular hemorrhage, and 49 (82%) had no or low-grade hemorrhage. Of the 11 infants with high-grade intraventricular hemorrhage, 8 (73%) had strabismus compared with 7 (14%) of 49 infants with no or low-grade hemorrhages who developed strabismus (P<0.001). The high-grade group also had a larger proportion of infants with ocular motility defects (P=0.008), nystagmus (P<0.001), optic nerve atrophy (P<0.001), and abnormal retinal findings (P=0.039). Additionally, these infants were more likely to have stage 3 or worse retinopathy of prematurity (P=0.003).
Conclusions:
These results confirm the findings of our earlier retrospective study, and suggest that the occurrence of high-grade intraventricular hemorrhage in the early postnatal period places these infants at significant risk for adverse ocular outcomes. These infants require close ophthalmologic surveillance.