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Published on: March 17, 2023
Suboptimal visual acuity and neurodevelopment at five years in children born very preterm: the EPIPAGE-2 cohort study
Yaman Hendi1, Véronique Pierrat2, Amandine Barjol3
1Adolphe de Rothschild Ophthalmological Foundation, Paris, France yamanhendi@gmail.com.
Insights
Suboptimal visual acuity (VA) is common in preterm children and linked to neurodevelopmental issues. Early neurovisual assessments are crucial for these vulnerable children.
Area of Science:
- Pediatric Ophthalmology
- Developmental Neuroscience
- Public Health
Background:
- Preterm infants often exhibit visual impairments beyond retinopathy of prematurity.
- Suboptimal visual acuity (VA) is defined as binocular VA between 5-6.3/10 and 8/10.
- The relationship between suboptimal VA and neurodevelopment in preterm children requires further investigation.
Purpose of the Study:
- To examine the association between suboptimal visual acuity and neurodevelopmental outcomes in children born preterm.
- To identify specific neurodevelopmental deficits associated with varying degrees of suboptimal VA.
Main Methods:
- Secondary analysis of the French EPIPAGE-2 cohort (24+0 to 31+6 weeks gestation).
- Children assessed at 5.5 years, categorized into VA groups: 5-6.3/10, 8/10, and 10/10 (reference).
- Neurodevelopment assessed using Wechsler scales (IQ), MABC-2 (motor skills), and SDQ (behavioral difficulties), with adjustments for confounding factors.
Main Results:
- 62% of preterm children exhibited suboptimal VA.
- Suboptimal VA was associated with significantly lower full-scale IQ scores.
- Children with suboptimal VA showed poorer motor skills (MABC-2) and increased behavioral difficulties (SDQ).
Conclusions:
- Suboptimal visual acuity is prevalent in preterm children and indicates a higher risk of neurodevelopmental challenges.
- Comprehensive neurodevelopmental and neurovisual evaluations are recommended for preterm infants with suboptimal VA.
- Findings highlight the importance of early screening and intervention for visual and neurological deficits in this population.
Introduction:
Children born preterm often have anatomical and functional visual abnormalities, even in the absence of retinopathy of prematurity. This includes suboptimal visual acuity (VA), defined as binocular VA between 5-6.3/10 and 8/10. We examine relationships between suboptimal VA and neurodevelopment in children born preterm.
Methods:
Secondary analysis of the French EPIPAGE-2 cohort with children born between 24+0 weeks and 31+6 weeks of gestation, eligible for follow-up at 5.5 years. Children were classified into three VA groups: 5-6.3/10, 8/10 and 10/10 as reference group. Neurodevelopment was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition, the Movement Assessment Battery for Children-II (MABC-2) and the Strengths and Difficulties Questionnaire (SDQ). Comparisons between groups were adjusted for neonatal and socioeconomic characteristics using generalised estimating equations models.
Results:
Among 1787 included children, 62% had suboptimal VA. Compared with the 10/10 VA group, the mean full-scale IQ decreased by -3.09 (95 % CI -4.75 to -1.42) and -4.97 (95 % CI -6.47 to -3.46) points, the mean MABC-2 total score by -0.66 (95 % CI -0.71 to -0.61) and -1.06 (95 % CI -1.09 to -1.00), and the mean total SDQ scores increased by 0.40 (95 % CI -0.16 to 0.94) and 0.60 (95 % CI 0.10 to 1.1) in groups with VA groups at 8/10 and 5-6.3/10, respectively.
Discussion:
In this French population-based cohort of children born preterm, suboptimal VA was frequent and associated with increased risk of neurodevelopmental difficulties. A comprehensive neurodevelopmental and neurovisual assessment is warranted in children born preterm with suboptimal VA.
