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Vision outcome at age 2 years in a low birth weight population
J A Pinto-Martin1, V Dobson, A Cnaan
1University of Pennsylvania School of Nursing, Philadelphia 19104, USA.
Insights
Vision problems are common in low birth weight infants, especially those with cerebral palsy. Early evaluation is crucial for infants with brain injuries to detect and manage visual impairments.
Area of Science:
- Pediatric Ophthalmology
- Neonatology
- Neuroscience
Background:
- Low birth weight infants are at increased risk for various health complications.
- Neonatal brain injury can have long-term consequences, including developmental and sensory deficits.
- Vision problems are a significant concern in this vulnerable population.
Purpose of the Study:
- To determine the prevalence of vision problems in low birth weight infants at two years of age.
- To investigate the association between neonatal brain injury and vision problems in this cohort.
- To identify specific risk factors for visual impairment in low birth weight infants.
Main Methods:
- A multi-center, population-based longitudinal study followed 721 low birth weight infants (500-2,000 gm).
- Prenatal and neonatal histories, including brain injury status, were prospectively collected.
- Visual acuity was assessed using the Teller Acuity Card Procedure; eye abnormalities were evaluated by a pediatric nurse practitioner.
Main Results:
- 8.9% of infants failed the visual acuity screen.
- Disabling cerebral palsy (OR=14.8), nondisabling cerebral palsy (OR=4.0), and low Apgar score (OR=2.4) were significant predictors of vision problems.
- Strabismus affected 17.5% of infants, with disabling cerebral palsy (OR=7.2) and longer hospital stay (OR=1.6) as key predictors.
Conclusions:
- Low birth weight infants with brain lesions leading to cerebral palsy face a heightened risk of vision problems.
- Early and thorough ophthalmological evaluation is recommended for these infants.
- Identifying risk factors like cerebral palsy and neonatal brain injury aids in targeted screening and intervention.
Abstract:
We assess the prevalence of vision problems in a cohort of low birth weight infants at age 2 years and the relationship of these problems to neonatal brain injury. Data on prenatal and neonatal history and brain injury status were prospectively collected on 721 children weighing 500-2,000 gm at birth enrolled in a multi-center, population-based longitudinal study. Visual acuity was evaluated using the Teller Acuity Card Procedure. Abnormalities of the eye were assessed by a specially trained pediatric nurse practitioner. Failure of the acuity screen occurred in 62 of 699 tested (8.9%). Multiple logistic regression analysis revealed that the only significant independent predictors of failure included presence of disabling cerebral palsy (DCP) (odds ratio [OR] = 14.8) or nondisabling cerebral palsy (NDCP) (OR = 4.0) and Apgar score of less than 5 at 5 minutes (OR = 2.4). Parenchymal brain injury (PEL) was of borderline significance. Strabismus was present in 123 of 702 children (17.5%). Multiple logistic regression analysis disclosed that the joint predictors of strabismus were presence of DCP (OR = 7.2) and length of hospital stay (OR = 1.6). We conclude that low birth weight infants with parenchymal brain lesions leading to cerebral palsy are at particular risk for vision problems early in life and should be carefully evaluated.