Retinopathy of prematurity associated with nonvisual impairment in childhood

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1. Retinopathy of prematurity was significantly associated with the presence of one or more nonvisual impairments at 5 years of age, including motor, cognitive, and/or auditory impairments. 

Evidence Rating Level: 3 (Average) 

Study Rundown: Retinopathy of prematurity describes the aberrant ocular vascularization that may develop in these individuals. Severe complications include visual deficits such as bilateral blindness, but these have become rare due to advances in screening and therapy. The authors of this study investigated whether infants with a history of retinopathy of prematurity were at increased risk for developing deficits unrelated to vision. The study found a significant association between retinopathy of prematurity and nonvisual impairments at 5 years of age, including motor, cognitive, and/or auditory impairments. Limitations of this study include those inherent to its observation design, including incomplete or partial follow-up records.

Based upon the findings of the study, clinicians should be aware of the potential for additional developmental difficulties in children with a history of retinopathy of prematurity in order to facilitate early recognition and intervention.

Click to read the study, published today in JAMA

Relevant Reading: Screening examination of premature infants for retinopathy of prematurity

In-Depth [observational exploratory analysis]: The study utilized data from the Caffeine for Apnea of Prematurity trial and included infants born with a birth weight between 500 and 1250 grams, and they were subsequently followed up at 5 years of age. Ninety-five infants were noted to have severe retinopathy of prematurity, as defined by stage 4 or 5 disease or receipt of retinal treatment. This cohort was compared to 1,487 infants with either no retinopathy of prematurity or untreated retinopathy of prematurity that was graded to be below stage 4 disease. Of infants with severe retinopathy of prematurity,13.5% of infants developed bilateral blindness at 5 years of age, versus 0.1% of those with no severe retinopathy (p<0.001). Of infants with severe retinopathy of prematurity, 39.5% exhibited one or more nonvisual impairments versus 15.8% of those with no severe retinopathy (p<0.001). Severe hearing loss, motor impairments and cognitive impairments were noted to occur significantly more frequently in those with severe retinopathy of prematurity versus those without (p<0.001). There were no significant differences noted in the presence of behavioral problems and poor general health status.

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