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Ophthalmologic Outcome of Extremely Preterm Infants at 6.5 Years of Age: Extremely Preterm Infants in Sweden Study
Kerstin M Hellgren1, Kristina Tornqvist2, Peter G Jakobsson3
1Department of Clinical Neuroscience, Karolinska Institutet, Astrid Lindgren Children's Hospital, Stockholm, Sweden.
Insights
Extremely preterm children often experience significant eye and visual problems, with retinopathy of prematurity being a key factor. These long-term sequelae highlight ongoing challenges in neonatal intensive care.
Area of Science:
- Ophthalmology
- Neonatology
- Pediatrics
Background:
- Extremely preterm (EPT) infants (<27 weeks' gestational age) face significant long-term health challenges.
- Major eye and visual problems are common sequelae of extreme prematurity.
- Retinopathy of prematurity (ROP) is a leading cause of visual impairment in preterm infants.
Purpose of the Study:
- To assess the ophthalmologic outcomes at 6.5 years of age in a national cohort of EPT children.
- To evaluate the impact of gestational age (GA) and treatment-requiring ROP on visual development.
Main Methods:
- A prospective national follow-up study included surviving EPT children born in Sweden (2004-2007) and a matched term control group.
- Ophthalmologic assessments included visual acuity, cycloplegic refraction, and manifest strabismus.
- Data were analyzed comparing EPT children with controls and correlating outcomes with GA and ROP status.
Main Results:
- At 6.5 years, 37.9% of EPT children had ophthalmologic abnormalities versus 6.2% in controls.
- Blindness (2.1%) and visual impairment (4.8% WHO criteria) were significantly higher in EPT children.
- Strabismus (17.4%) and refractive errors (29.7%) were more prevalent in EPT children; treatment-requiring ROP strongly impacted visual impairment and strabismus, but not refractive errors.
Conclusions:
- Major eye and visual problems are frequent in EPT children at 6.5 years of age.
- Treatment-requiring ROP is a more significant factor than GA for visual impairment and strabismus.
- Ophthalmologic issues remain a substantial long-term consequence of extreme prematurity, even with modern neonatal care.
Importance:
This follow-up study of extremely preterm (EPT) children (<27 weeks' gestational age [GA] at birth) revealed major eye and visual problems in 37.9% (147 of 388) of all EPT infants and in 55.4% (67 of 121) of the most immature subgroups at 6.5 years of age. These major eye and visual problems were strongly associated with treatment-requiring retinopathy of prematurity (ROP).
Objectives:
To investigate the ophthalmologic outcome of a national cohort of EPT children at 6.5 years of age and to evaluate the impact of prematurity and ROP.
Design, Setting, And Participants:
All surviving EPT children born in Sweden between April 1, 2004, and March 31, 2007, were included and compared with a matched term control group, as part of a prospective national follow-up study.
Main Outcomes And Measures:
Visual acuity, refraction in cycloplegia, and manifest strabismus were evaluated and compared with GA at birth and with treatment-requiring ROP.
Results:
The study cohort comprised 486 participants. The mean (SD) GA of the children who were included was 25 (1) weeks, and 45.7% (222 of 486) were female. At a median age of 6.6 years, 89.3% (434 of 486) of eligible EPT children were assessed and compared with 300 control group children. In the EPT group, 2.1% (9 of 434) were blind, 4.8% (21 of 434) were visually impaired according to the World Health Organization criteria, and 8.8% (38 of 434) were visually impaired according to the study criteria. Strabismus was found in 17.4% (68 of 390) and refractive errors in 29.7% (115 of 387) of the EPT children compared with 0% (0 of 299) and 5.9% (17 of 289), respectively, of the control children (P < .001). Altogether at 6.5 years of age, 37.9% (147 of 388) of the EPT children had some ophthalmologic abnormality compared with 6.2% (18 of 290) of the matched control group (95% CI of the difference, 26.1%-37.2%). When treatment-requiring ROP was adjusted for, no significant association between GA and visual impairment could be detected. For refractive errors, the association with GA remained after adjustment for treatment-requiring ROP (odds ratio, 0.72; 95% CI, 0.58-0.91 for each 1-week increment).
Conclusions And Relevance:
In a Swedish national cohort of EPT children at 6.5 years of age, major eye and visual problems were frequently found. Treatment-requiring ROP was a stronger impact factor than GA on visual impairment and strabismus, but not on refractive errors, as a whole. In modern neonatal intensive care settings, ophthalmologic problems continue to account for a high proportion of long-term sequelae of prematurity.
