BAD BRAINS AND BAD EYES IN VERY LOW BIRTHWEIGHT (VLBW) PREMATURE INFANTS: IS THERE A CONNECTION? † 1153

Abstract

BACKGROUND: VLBW premature infants are at high risk for developing cystic periventricular leukomalacia (CPVL), a powerful predictor of later cerebral palsy and cognitive deficits. This group of infants is also at high risk for developing retinopathy of prematurity (ROP) and subsequent visual disturbances. To date there are no data assessing whether there is an association between these two disabling conditions. We performed this investigation to assess for any such relationship. METHODS: As part of a federally-funded project evaluating factors associated with brain injury in premature infants, we enrolled a cohort of 137 ventilated VLBW premature infants at high risk for brain injury. The infants were followed longitudinally for assessment of outcomes. Serial head ultrasounds were obtained during their neonatal courses. Starting at 4-6 weeks after birth, all survivors were examined for the presence and staging of ROP at regular intervals. Mild ROP was defined as stage 1 or 2, while moderate to severe ROP was defined as stage 3 or greater. RESULTS: 137 premature infants were enrolled. Mean gestational age was 27.3 weeks and mean birthweight was 1031 grams. 121 (88%) survived the neonatal hospitalizatation. A mean of 9.3 head ultrasounds were performed on each infant during the hospitalization. 38/137 (28%) of the infants were found to have CPVL. 19/137 (14%) were noted to have moderate to severe ROP. 9 of 19 (47%) infants with moderate to severe ROP had CPVL compared to 29/102 (28%) infants with either no ROP or mild ROP(P=0.1025). Post-hoc analysis revealed that for the number of infants in this cohort, there was only 50% power of detecting a difference between groups (ie, the number of at-risk infants was insufficient). CONCLUSION: There is a trend for infants with the worst ROP to have concomitant CPVL, an association which would be a harbinger for extremely poor neurodevelopmental outcome. If other investigations confirm this association, the information would be important in discussing prognosis with parents.