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Associations between systemic health and retinal nerve fibre layer thickness in preterm infants at 36 weeks
Liangbo L Shen1, Shwetha Mangalesh2, Suzanne M Michalak2
1Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.
Insights
Low infant weight and sepsis/necrotising enterocolitis (NEC) are linked to thinner retinal nerve fibre layer (RNFL) in preterm infants. This suggests systemic health factors may impact early neurodevelopment.
Area of Science:
- Neonatal ophthalmology
- Neurodevelopmental research
- Preterm infant health
Background:
- Systemic diseases in neonates can impair neurodevelopment in preterm infants.
- Retinal nerve fibre layer (RNFL) thickness is a potential indicator of neurodevelopmental outcomes.
Purpose of the Study:
- To investigate associations between systemic health factors and RNFL thickness in preterm infants.
- To identify specific systemic conditions impacting retinal neurodevelopment in this population.
Main Methods:
- Prospective enrollment of preterm infants.
- Optical coherence tomography (OCT) imaging at 36±1 weeks postmenstrual age (PMA).
- Univariable and multivariable regression analyses of 29 systemic health factors and RNFL thickness.
Main Results:
- RNFL thickness was positively associated with infant weight at imaging.
- RNFL thickness was negatively associated with sepsis/necrotising enterocolitis (NEC).
- Infants with sepsis/NEC had significantly thinner RNFL compared to those without.
Conclusions:
- Low infant weight and sepsis/NEC are independently associated with thinner RNFL in preterm infants at 36 weeks PMA.
- This study suggests sepsis/NEC may negatively affect retinal neurodevelopment.
- Further longitudinal studies are warranted to confirm this relationship.
Background/Aims:
Neonatal insults from systemic diseases have been implicated in the pathway of impaired neurodevelopment in preterm infants. We aimed to investigate the associations between systemic health factors and retinal nerve fibre layer (RNFL) thickness in preterm infants.
Methods:
We prospectively enrolled infants and imaged both eyes at 36±1 weeks postmenstrual age (PMA) using a hand-held optical coherence tomography system at the bedside in the Duke intensive care nurseries. We evaluated associations between RNFL thickness and 29 systemic health factors using univariable and multivariable regression models.
Results:
83 infants with RNFL thickness measures were included in this study. Based on the multivariable model, RNFL thickness was positively associated with infant weight at imaging and was negatively associated with sepsis/necrotising enterocolitis (NEC). RNFL thickness was 10.4 µm (95% CI -15.9 to -4.9) lower in infants with than without sepsis/NEC in the univariable analysis (p<0.001). This difference remained statistically significant after adjustment for confounding variables in various combinations (birth weight, birthweight percentile, gestational age, infant weight at imaging and growth velocity). A 250 g increase in infant weight at imaging was associated with a 3.1 µm (95% CI 2.1 to 4.2) increase in RNFL thickness in the univariable analysis (p<0.001).
Conclusions:
Low infant weight and sepsis/NEC were independently associated with thinner RNFL in preterm infants at 36 weeks PMA. To our knowledge, this study is the first to suggest that sepsis/NEC may affect retinal neurodevelopment. Future longitudinal studies are needed to investigate this relationship further.
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