Abstract
Purpose: To evaluate the relationship between retinopathy of prematurity (ROP) severity and neurodevelopmental outcomes in premature neonates at 0–36 months corrected age.Methods: A retrospective chart review was performed on 228 neonates screened for ROP at the UCLA Mattel Children's Hospital between 2011 and 2018. Demographic information, clinical outcomes, ROP severity (no ROP, type 1 ROP, type 2 ROP), and Bayley-III neurodevelopmental scores were collected. Infants were grouped into corrected age cohorts (0–12, 12–24, and 24–36 months) to assess neurodevelopmental outcomes with increasing age. Within each age cohort, ANOVA and Chi-Square testing were used to detect differences in birth characteristics and neurodevelopmental scores between infants with type 1 ROP, type 2 ROP, or no ROP. Univariable analyses assessed the relationship between ROP severity and neurodevelopmental outcomes within each age cohort. A multivariable analysis was then performed to determine if ROP severity remained significantly associated with worse neurodevelopmental scores after controlling for birth weight (BW), intraventricular hemorrhage grade (IVH), health insurance type, male sex, and age at Bayley testing.Results: Without controlling for factors associated with prematurity, neonates with type 1 ROP had poorer cognition (p = 0.001) and motor (p = 0.006) scores at ages 0–12 months and poorer cognition (p = 0.01), language (p = 0.04) and motor (p = 0.04) scores at ages 12–24 months than infants without ROP, but no significant differences were detected at ages 24–36 months. After adjusting for BW, IVH, insurance type, male sex, and age at Bayley testing, ROP severity was no longer associated with worse neurodevelopmental scores in any domain.Conclusion: This study emphasizes that poorer neurodevelopmental outcomes in preterm neonates are most likely related to lower birthweight, associated co-morbidities of prematurity, and socioeconomic factors such as health insurance, not severity of ROP itself.
Highlights
∼11.1% of births are premature [1,2,3]
Given the shared risk factors for neurological and visual impairment in preterm infants, the purpose of this study was to evaluate the relationship between retinopathy of prematurity (ROP) severity and neurodevelopmental outcomes at 0–12, 12–24, and 24–36 months of corrected age, while considering variables associated with prematurity known to portend worse neurodevelopmental outcomes [gestational age, birth weight, bronchopulmonary dysplasia (BPD), intraventricular hemorrhage grade (IVH), and socioeconomic status (SES)]
Thirty-eight infants were treated for ROP; this included infants with type 1 ROP and those with persistent type 2 ROP (Table 1)
Summary
∼11.1% of births are premature [1,2,3]. advances in neonatal healthcare have improved outcomes for premature infants, they are still at risk of developing retinopathy of prematurity (ROP) and poorer visual outcomes later in life [4,5,6]. The more premature or smaller a preterm baby is at birth, the higher their risk of developing more severe ROP. In ROP, relatively elevated oxygen levels in preterm infants requiring oxygen therapy for immature lungs promote vascular attenuation and subsequently lead to retinal hypoxia [8, 9]. This period of local hypoxia results in increased release of hypoxia-inducible factor 1 alpha (Hif1a) and vascular endothelial growth factor (VEGF), stimulating pathological proliferation of retinal blood vessels, which in severe cases, can lead to traction on the retina, retinal detachment, and permanent blindness [8, 9]
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