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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Gestational age, maternal smoking, neurological lesion and retinopathy predict strabismus at age 5.5 in preterm
Thibaut Chapron1,2, Véronique Pierrat1,3, Amandine Barjol2
1Université Paris Cité, centre de recherche en épidémiologie et statistiques, équipe de recherche en épidémiologie obstétricale périnatale et pédiatrique, institut national de la santé et de la recherche médicale, institut national de recherche pour l'agriculture l'alimentation et l'environnement, Paris, France.
Insights
Premature birth increases strabismus risk. Maternal smoking, severe brain lesions, and severe retinopathy of prematurity (ROP) are key neonatal risk factors for strabismus in preterm children at 5.5 years old.
Area of Science:
- Ophthalmology
- Neonatology
- Epidemiology
Background:
- Prematurity is a known risk factor for strabismus.
- The influence of intermediate factors like retinopathy of prematurity (ROP) and neurological lesions on strabismus development in preterm infants requires further investigation.
Purpose of the Study:
- To identify neonatal risk factors associated with strabismus at 5.5 years of age in children born preterm.
- To analyze the direct and total effects of gestational age on the risk of developing strabismus.
Main Methods:
- Prospective, population-based cohort study of preterm children (gestational age ≤ 34 weeks).
- Data collected from the 'étude épidémiologique sur les petits âges gestationnels 2' cohort.
- Strabismus assessed at 5.5 years; risk factors analyzed using generalized estimating equations and a directed acyclic graph.
Main Results:
- Strabismus was diagnosed in 274 out of 2419 preterm children (11.3%) at 5.5 years.
- Maternal smoking during pregnancy (OR 1.8), severe neonatal cerebral lesions (OR 2.9), and severe ROP (OR 4.2) were identified as independent risk factors for strabismus.
- The direct effect of gestational age on strabismus risk remained statistically significant after adjustments (p < 0.001).
Conclusions:
- Preterm children require continued strabismus screening at 5.5 years, irrespective of severe cerebral lesions or ROP.
- Encouraging smoking cessation during pregnancy is crucial for reducing strabismus risk in preterm infants.
Aim:
Prematurity is a risk factor for strabismus, but the roles of intermediate factors like retinopathy of prematurity (ROP) and neurological lesions are less understood. We aimed to identify neonatal risk factors for strabismus at age 5.5 in preterm children.
Methods:
Data were extracted from the étude épidémiologique sur les petits âges gestationnels 2 cohort, a French prospective population-based study of preterm children born in 2011 with gestational age of 34 weeks or less. Strabismus was recorded during a medical interview at 5.5 years. Using a directed acyclic graph, intermediate and confounding factors were identified. Total and direct effects of gestational age on strabismus risk were analysed using generalised estimating equation.
Results:
Among 2419 children assessed, 274 (52.6% male) presented strabismus at 5.5 years. The direct effect of gestational age remained significant after adjustment (p < 0.001). In the complete imputed model: maternal smoking during pregnancy (odds ratio, OR 1.8; 95% confident interval, 95% CI 1.3-2.6), neonatal severe cerebral lesions (OR 2.9, 95% CI 1.8-4.6) and severe ROP (OR 4.2, 95% CI 1.9-9.0) were independent risk factors.
Conclusion:
Special attention is needed regarding strabismus screening at age 5.5 in preterm children, even without severe cerebral lesions and ROP. Smoking cessation during pregnancy should be encouraged.
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