Retinopathy in Preemies Linked to Nonvisual Problems Later

Steven Fox

February 04, 2014

Children born prematurely and diagnosed with severe retinopathy are at increased risk of having nonvisual disabilities by the time they reach age 5 years, according to a study published in the February 5 issue of JAMA.

"Although the incidence of severe retinopathy has increased since the late 1980s, blindness caused by retinopathy has become rare in developing countries," write Barbara Schmidt, MD, from the Division of Neonatology, Hospital of the University of Pennsylvania, Philadelphia, and colleagues. "Consequently, clinicians and parents may conclude that severe retinopathy is no longer associated with childhood impairments."

The researchers examined data from the Caffeine for Apnea of Prematurity trial, a multinational study that included very premature infants born in 31 centers in Canada, Australia, Europe, Israel, and the United States.

The children were born between 1999 and 2004 and were followed-up 5 years later (2005-2011) to assess whether retinopathy in early life is associated with an increased risk for nonvisual disabilities at 5 years of age. Nonvisual disabilities included motor problems, cognitive problems, behavioral problems, poor general health, and severe hearing loss. Birth weights ranged from 500 to 1250 g.

Of 1582 children who underwent assessment at 5 years, 95 had severe retinopathy. Of those, 39.5% had at least 1 nonvisual disability compared with 15.8% of children without retinopathy. In addition, 14.9% of the children with severe retinopathy had more than 1 nonvisual problem compared with only 2.4% of children without retinopathy.

"Although the risk of vision loss was increased after severe retinopathy, most children with severe retinal disease did not become bilaterally blind," the researchers write, adding that unfavorable prenatal factors associated with retinopathy, such as multiple gestation, apnea, intracranial hemorrhage, anemia, sepsis, prolonged mechanical ventilation, multiple transfusions, and light exposure, may also cause damage to the immature brain.

Compared with children without retinopathy, those with that diagnosis were 3 to 4 times more likely to have severe hearing loss or motor/cognitive impairment.

These results may help clinicians to counsel parents as well as identify high-risk infants for long-term follow-up, the authors conclude.

The Caffeine for Apnea of Prematurity was supported by a grant from the Canadian Institutes of Health Research and by the National Health and Medical Research Council of Australia. The authors have disclosed no relevant financial relationships.

JAMA. 2014;311:524-525. Abstract

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