Follow-up at 30 months' corrected age reveals eye and visual problems in one-third of children born extremely prematurely (<27 weeks' gestation).
To investigate the ophthalmologic outcome of extremely preterm children at 30 months' corrected age.
DESIGN, SETTING, AND PARTICIPANTS
A prospective, population-based follow-up study (Extremely Preterm Infants in Sweden Study [EXPRESS]) was conducted in Sweden. The population included extremely preterm infants (<27 weeks' gestation) born in Sweden between 2004 and 2007, of whom 491 survived until age 2.5 years. Screening for retinopathy of prematurity (ROP) was performed in the neonatal period. At 30 months' corrected age, an ophthalmologic assessment was performed in 411 of 491 children (83.7%).
MAIN OUTCOMES AND MEASURES
Visual acuity, manifest strabismus, and refractive errors were evaluated.
Visual impairment was identified in 3.1% of the children, and 1.0% were blind. Refractive errors, defined as myopia less than -3 diopters (D), hypermetropia greater than +3 D, astigmatism 2 D or more, and/or anisometropia 2 D or more, were found in 25.6% of the children, and 14.1% had manifest strabismus. There were significant associations between visual impairment and treated ROP (P = .02), cognitive disability (P < .001), and birth weight (P = .02). Multiple regression analyses revealed significant associations between strabismus and treated ROP (P < .001), cognitive disability (P < .01), and cerebral palsy (P = .02). Refractive errors were significantly correlated with severity of ROP (right eye, P < .001; left eye, P < .01). Children who had been treated for ROP had the highest frequency (69.0%) of eye and visual abnormalities.
CONCLUSIONS AND RELEVANCE
One-third of the extremely prematurely born children in this study had some kind of eye or visual problems, such as visual impairment, strabismus, or major refractive error. Despite being born extremely preterm, the present cohort has a similar prevalence of blindness and visual impairment as in previous Swedish cohorts of children born less prematurely.
Various neurologic, cognitive, and behavioral sequels are well-known complications of premature birth.1- 3 Ophthalmologic problems are also well known, with retinopathy of prematurity (ROP) being the major threat in the neonatal period and an important cause of childhood blindness worldwide.4 In older children, an increase in strabismus and refractive errors, as well as deficiencies in visual acuity, contrast sensitivity, stereopsis, visual fields, accommodation, and visual perception, have been shown in various long-term population-based studies.5- 10
Modern neonatal care is continuously improving, providing us with a new population of survivors born extremely preterm. The long-term outcome of this group of children is of utmost interest. A prospective national study (Extremely Preterm Infants in Sweden Study [EXPRESS])11- 13 of Swedish infants with a gestational age (GA) of less than 27 weeks born during 2004-2007 revealed high survival (70%) and high incidences of severe (35%) and treatment-requiring (20%) ROP. In an ongoing, long-term follow-up of this cohort, the neurologic and developmental outcome at 30 months’ corrected age has recently been reported.14 The present study aimed to investigate the ophthalmologic outcome of this group of extremely preterm children.
2014. Vol. 132, no 2, 182-189 p.