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Refractive status at birth: its relation to newborn physical parameters at birth and gestational age
Raji Mathew Varghese1, Vishnubhatla Sreenivas, Jacob Mammen Puliyel
1Department of Neonatology, St Stephens Hospital, Delhi, India.
Insights
Birth weight, not gestational age, is a stronger predictor of refractive error in newborns. This finding is crucial for identifying infants who may need early screening for vision problems, particularly in regions with high rates of intrauterine malnutrition.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatrics
Background:
- Refractive status at birth is linked to gestational age, with preterm infants often myopic and term infants hypermetropic.
- Intrauterine growth indicators like birth weight, head circumference, and length are potential factors influencing neonatal refractive status.
Purpose of the Study:
- To investigate the correlation between refractive status (mean spherical equivalent, astigmatism, anisometropia) and physical growth parameters in newborns.
- To determine the independent predictors of refractive error among gestational age, birth weight, head circumference, and length.
Main Methods:
- A study involving 599 newborn babies, with refraction performed within the first week of life using cycloplegia.
- Analysis of refractive status (MSE, astigmatism, anisometropia) against gestational age, birth weight, head circumference, and length.
- Application of simple and multiple linear regression analyses to identify associations and independent predictors.
Main Results:
- While all growth parameters showed a significant relation to refractive error in simple regression, only gestational age and weight remained significant in multiple regression.
- Birth weight demonstrated a higher correlation with Mean Spherical Equivalent (MSE) than gestational age (partial correlation of 0.28 vs. 0.10, adjusted for each other).
- Refractive error is significantly associated with birth weight and gestational age in newborns.
Conclusions:
- This study highlights birth weight as a more critical factor than gestational age for screening refractive errors in newborns.
- The findings suggest prioritizing birth weight for refractive error screening, especially in developing countries with higher incidences of intrauterine malnutrition.
- This research provides novel insights into the relationship between early growth parameters and neonatal refractive status.
Background:
Refractive status at birth is related to gestational age. Preterm babies have myopia which decreases as gestational age increases and term babies are known to be hypermetropic. This study looked at the correlation of refractive status with birth weight in term and preterm babies, and with physical indicators of intra-uterine growth such as the head circumference and length of the baby at birth.
Methods:
All babies delivered at St. Stephens Hospital and admitted in the nursery were eligible for the study. Refraction was performed within the first week of life. 0.8% tropicamide with 0.5% phenylephrine was used to achieve cycloplegia and paralysis of accommodation. 599 newborn babies participated in the study. Data pertaining to the right eye is utilized for all the analyses except that for anisometropia where the two eyes were compared. Growth parameters were measured soon after birth. Simple linear regression analysis was performed to see the association of refractive status, (mean spherical equivalent (MSE), astigmatism and anisometropia) with each of the study variables, namely gestation, length, weight and head circumference. Subsequently, multiple linear regression was carried out to identify the independent predictors for each of the outcome parameters.
Results:
Simple linear regression showed a significant relation between all 4 study variables and refractive error but in multiple regression only gestational age and weight were related to refractive error. The partial correlation of weight with MSE adjusted for gestation was 0.28 and that of gestation with MSE adjusted for weight was 0.10. Birth weight had a higher correlation to MSE than gestational age.
Conclusion:
This is the first study to look at refractive error against all these growth parameters, in preterm and term babies at birth. It would appear from this study that birth weight rather than gestation should be used as criteria for screening for refractive error, especially in developing countries where the incidence of intrauterine malnutrition is higher.
