Systemic Factors Associated with a Thinner Choroid in Preterm Infants
Suzanne M Michalak1, Shwetha Mangalesh1, Liangbo L Shen2
1Department of Ophthalmology, Duke University School of Medicine, Durham North Carolina.
Insights
A thinner choroid in preterm infants is linked to slower growth and prolonged oxygen use. These factors may impact visual development, warranting further research.
Area of Science:
- Ophthalmology
- Neonatology
- Developmental Biology
Background:
- Choroidal thickness is a potential indicator of visual health in infants.
- Preterm infants, especially those with low birth weight, are at risk for poor visual outcomes.
- Systemic health factors may influence choroidal development.
Purpose of the Study:
- To identify systemic health factors associated with a thinner choroid in preterm infants.
- To investigate the relationship between choroidal thickness and infant health parameters.
Main Methods:
- Prospective observational study (BabySTEPS) of infants undergoing retinopathy of prematurity screening.
- Handheld optical coherence tomography (OCT) imaging at 36 ± 1 weeks' postmenstrual age (PMA).
- Correlation analysis of choroidal thickness with maternal and infant clinical data.
Main Results:
- Mean subfoveal choroidal thickness was 231 ± 78 μm in 82 infants.
- Univariate analysis showed associations between thinner choroid and decreased growth velocity, lower birth weight, smaller head circumference, younger gestational age, patent ductus arteriosus, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, pulmonary interstitial emphysema, and oxygen support.
- Multivariate analysis identified growth velocity and oxygen support at 36 weeks PMA as independent predictors of thinner choroid.
Conclusions:
- Choroidal development in preterm infants is independently associated with growth velocity and prolonged oxygen support.
- These findings suggest a link between early life growth and choroidal development.
- Further longitudinal studies are needed to confirm these associations and their impact on visual outcomes.
Purpose:
To identify systemic health factors associated with a thinner choroid, which has been hypothesized as a cause of poor visual outcomes in low-birth weight infants.
Design:
The prospective, observational Study of Eye Imaging in Preterm Infants (BabySTEPS) enrolled infants recommended for retinopathy of prematurity screening based on the American Association of Pediatrics guidelines.
Participants:
Infants who underwent imaging with investigational handheld OCT at 36 ± 1 weeks' postmenstrual age (PMA) as part of BabySTEPS.
Methods:
Average choroidal thickness was measured across the central subfoveal 1 mm. We concurrently collected maternal and infant clinical health data. Univariate and multivariate linear regression analyses were performed to evaluate factors associated with choroidal thickness. The left and right eyes showed similar thicknesses, so their average was used for analysis.
Main Outcomes Measures:
Association between infant health factors and subfoveal choroidal thickness.
Results:
Subfoveal choroidal thickness was measurable in 82 of 85 infants and 94% of eyes. Mean choroidal thickness was 231 ± 78 μm. In the univariate analysis, a thinner choroid was associated with decreased growth velocity (P < 0.001), lower birth weight (P < 0.001), smaller head circumference (P < 0.001), younger gestational age (P = 0.01), the presence of patent ductus arteriosus (P = 0.05), sepsis or necrotizing enterocolitis (P = 0.03), bronchopulmonary dysplasia (P = 0.03), pulmonary interstitial emphysema (P = 0.002), more days on oxygen support (P < 0.001), and being on oxygen support at 36 weeks (P < 0.001) and at the time of imaging (P < 0.001). In the multivariate analysis, growth velocity (P = 0.002) and oxygen support at the time of OCT imaging (P = 0.004) remained associated with a thinner choroid.
Conclusions:
A thinner choroid is associated independently with growth velocity and receiving oxygen support at 36 ± 1 weeks PMA. This suggests that choroidal development in preterm infants may be related to growth rate in the first weeks of life and the prolonged use of supplemental oxygen. Longitudinal studies are needed to assess differences in choroidal thickness before 36 weeks PMA and to assess their impact on visual outcomes.
