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Published on: November 20, 2015
White-matter injury is associated with impaired gaze in premature infants
Hannah C Glass1, Shinji Fujimoto, Camilla Ceppi-Cozzio
1Department of Neurology, University of California at San Francisco, San Francisco, California, USA.
Insights
Diffuse white-matter injury in premature infants impacts visual function. Clinical gaze assessments can help predict white-matter injury, aiding early detection of visual impairment in neonates.
Area of Science:
- Neonatal neurology
- Pediatric ophthalmology
- Neuroimaging
Background:
- Periventricular leukomalacia is a known risk factor for visual impairment in premature infants.
- The effect of diffuse white-matter injury on early visual function remains unclear.
- Magnetic resonance imaging (MRI) is crucial for detecting white-matter injury.
Purpose of the Study:
- To investigate the association between clinical visual-gaze assessments and white-matter injury in premature neonates.
- To determine if visual-gaze scores can predict white-matter abnormalities detected by MRI.
Main Methods:
- Developed two 5-point visual-gaze scoring systems.
- Analyzed data from 93 premature neonates (<34 weeks gestational age).
- Correlated gaze scores with MRI findings of white-matter injury.
Main Results:
- Older postmenstrual age correlated with higher visual-gaze scores.
- Infants with moderate/severe white-matter injury showed significantly lower gaze scores.
- A combined score >or=9 at >or=36 weeks postmenstrual age predicted normal white matter with 84% sensitivity and 100% specificity.
Conclusions:
- Clinical visual-gaze assessments are associated with white-matter injury in premature infants.
- These assessments may help identify infants at risk for visual impairment due to white-matter damage.
- White-matter injury can affect visual function even before term-equivalent age.
Abstract:
Periventricular leukomalacia is a risk factor for visual impairment in children born prematurely. The impact of diffuse white-matter injury, as detected on magnetic resonance imaging, on early visual function is unknown. We developed two 5-point visual-gaze scores to analyze the association between this clinical assessment and white-matter injury in 93 premature neonates <34 weeks of gestational age at birth. Older postmenstrual age was associated with higher values of the two gaze scores. Infants with moderate or severe white-matter injury had lower scores than their peers without white-matter injury (0.41 points, 95% confidence interval of 0.13-0.69 for visual fixation score; and 0.70 points, 95% confidence interval of 0.30-1.10 for conjugate score, P < 0.005). Using the results from both scales, a score of >or=9 in an infant examined at >or=36 weeks postmenstrual age predicted normal white matter on magnetic resonance examination, with a sensitivity of 84% and a specificity of 100%. These preliminary findings suggest that white-matter injury affects visual function even before term equivalent postmenstrual age.
