Retrospective evaluation of ophthalmological and neurological outcomes for infants born before 24 weeks gestational age in a Swedish cohort
Gerd Holmström,
Ann Hellström,
Lotta Gränse,
Marie Saric,
Birgitta Sunnqvist,
Eva Larsson,
Eva Morsing,
Lena Hellström-Westas,
Pia Lundgren,
Lena Jacobson,
Abbas Al-Hawasi,
Mats Johnson,
Alexander Rakow,
Karin Sävman,
Lois Smith,
Anna‐Lena Hård
Affiliations
Gerd Holmström
Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
Ann Hellström
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
Lotta Gränse
Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
Marie Saric
Department of Clinical Sciences, Ophthalmology, Umeå University, Umeå, Sweden
Birgitta Sunnqvist
Länssjukhuset Ryhov, Jönköping, Sweden
Eva Larsson
Department of Neuroscience/Ophthalmology, Uppsala University, Uppsala, Sweden
Eva Morsing
Department of Pediatrics, Clinical Sciences Lund, Skåne University Hospital Lund, Lund, Sweden
Lena Hellström-Westas
3 Department of Women`s and Children`s Health, Uppsala University, Uppsala, Sweden
Pia Lundgren
Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
Lena Jacobson
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
Abbas Al-Hawasi
Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
Mats Johnson
Gillberg Neuropsychiatry Centre, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
Alexander Rakow
Department of Woman and Child Health, Karolinska Institutet, Stockholm, Sweden
Karin Sävman
Region Västra Götaland, Department of Neonatology, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
Lois Smith
The Department of Ophthalmology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
Anna‐Lena Hård
The Sahlgrenska Centre for Pediatric Ophthalmology Research, Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
Objectives To retrospectively evaluate ophthalmological and neurological outcomes in a Swedish cohort of infants born before 24 weeks gestational age (GA) and explore risk factors for visual impairment.Setting Eye and paediatric clinics in Sweden.Participants Infants screened for retinopathy of prematurity (ROP) (n=399), born before 24 weeks GA, 2007–2018. Cases were excluded if ophthalmological follow-up records could not be traced.Primary and secondary outcome measures Primary outcomes were ophthalmological, including visual acuity (VA), refractive error, strabismus, nystagmus and cerebral visual impairment (CVI). Secondary outcomes comprised neonatal and neurological morbidities. Data were retrospectively retrieved from medical records.Results The 355 assessed children had a median GA of 23 weeks and 2 days and a median birth weight of 565 g. At the last available ophthalmological examination, the median age was 4.8 years (range 0.5–13.2 years). Nystagmus was recorded in 21.1%, strabismus in 34.8%, and 51.0% wore spectacles. Seventy-three of 333 (21.9%) were visually impaired, defined as being referred to a low vision clinic and/or having a VA less than 20/60 at 3.5 years of age or older. ROP treatment was a significant risk factor for visual impairment (OR 2.244, p=0.003). Visually impaired children, compared with children without visual impairment, more often had neurological deficits such as intellectual disability 63.8% versus 33.3% (p<0.001), epilepsy 21.1% versus 7.5% (p=0.001) and autism spectrum disorders 32.8% versus 20.9% (p=0.043). Nine of the 355 children had been diagnosed with CVI.Conclusions Children born before 24 weeks GA frequently had visual impairment in association with neurological deficits. CVI was rarely diagnosed. A multidisciplinary approach for the evaluation and habilitation of these vulnerable infants is warranted. National follow-up guidelines need to be developed and implemented.
