Delayed diagnosis of congenital cataract in preterm infants: Findings from the IoLunder2 cohort study
Ameenat Lola Solebo1,2,3,4, Jugnoo Sangeeta Rahi1,2,3,4,
1Population, Practice and Policy Research and Teaching Department, UCL GOS Institute of Child Health, London, United Kingdom.
Insights
Congenital cataract detection is often delayed in preterm infants compared to full-term infants. This delay is linked to moderate/late preterm birth, highlighting a need to improve screening effectiveness for this vulnerable population.
Area of Science:
- Ophthalmology
- Neonatology
- Public Health
Background:
- Early detection of congenital cataract is crucial for optimal outcomes in children.
- Preterm infants may experience delayed diagnosis of congenital cataract due to challenges in healthcare intervention delivery.
- This study investigates the association between preterm birth and delayed congenital cataract detection.
Purpose of the Study:
- To test the hypothesis that congenital cataract detection is delayed in preterm infants compared to term/post-term infants.
- To assess the effectiveness of current screening programs for congenital cataract in preterm infants.
- To identify factors associated with late detection of congenital cataract in infants.
Main Methods:
- A secondary analysis of a prospective, population-based cohort study was performed.
- A nested case-control study included children diagnosed with congenital cataract requiring surgery within the first two years of life (2009-2010, UK & Ireland).
- Multivariable logistic regression assessed the association between late detection (post-8 weeks) and preterm birth (gestational age < 37 weeks).
Main Results:
- Out of 186 children with congenital cataract, 17 (9%) were born preterm (24-37 weeks gestational age).
- Neonatal detection occurred in 34% (64/186) and late detection in 34% (64/186) of cases.
- Late detection was independently associated with moderate/late preterm birth (aOR 3.0, 95% CI 1.1-8.5).
Conclusions:
- Congenital cataract is not effectively detected in moderate/late preterm infants through routine screening programs, despite recommendations for enhanced surveillance.
- Improved screening program effectiveness is necessary for preterm infants (32+ weeks gestational age).
- Healthcare systems must ensure that the competing needs of preterm infants do not impede universal child health interventions, including cataract screening.
Background And Objectives:
Early detection is critical to achieving optimal outcomes in children with congenital cataract. We hypothesized that detection of congenital cataract in preterm infants would be delayed compared with term/post-term peers due to delayed delivery of whole population child health interventions.
Methods:
Secondary analysis of data using a nested case-control study approach in a prospective population-based cohort study. Inclusion criteria comprised children diagnosed with congenital cataract requiring surgical intervention during the first two years of life in UK and Ireland in 2009 and 2010. Association between late detection (after eight weeks post-natal age, ie outside the neonatal and infant eye national screening programme) of cataract and preterm birth (gestational age less than 37 weeks) was assessed using multivariable logistic regression.
Results:
Of 186 children with congenital cataract, 17 children were born preterm (9%, gestational age range 24-37weeks). Neonatal detection occurred in 64/186 (34%), and late detection in 64 children (34%). Late detection was independently associated with premature birth, specifically moderate/late preterm birth (adjusted odds ratio 3.0, 95%CI 1.1 to 8.5).
Conclusions:
Our findings suggest that, despite enhanced eye surveillance being recommended for those born moderate/late preterm (32+ weeks gestational age, ie not eligible for retinopathy of prematurity screening), congenital cataract is not being effectively detected through the routine screening programme for this vulnerable group. It is necessary to improve the effectiveness of the screening programme, and care must be taken to ensure that competing health care needs of preterm children do not prevent universal child health interventions.
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