Ophthalmologic Outcomes of Children Born Premature Without ROP: Correlations With Gestational Age and Psychomotor Development

Risk of Developmental Disorders in Children Born at 32 to 38 Weeks' Gestation: A Meta-Analysis

CONTEXT

Very preterm birth (<32 weeks) is associated with increased risk of developmental disorders. Emerging evidence suggests children born 32 to 38 weeks might also be at risk.

OBJECTIVES

To determine the relative risk and prevalence of being diagnosed with, or screening positive for, developmental disorders in children born moderately preterm, late preterm, and early term compared with term (≥37 weeks) or full term (39-40/41 weeks).

DATA SOURCES

Medline, Embase, Psychinfo, Cumulative Index of Nursing, and Allied Health Literature.

STUDY SELECTION

Reported ≥1 developmental disorder, provided estimates for children born 32 to 38 weeks.

DATA EXTRACTION

A single reviewer extracted data; a 20% sample was second checked. Data were pooled using random-effects meta-analyses.

RESULTS

Seventy six studies were included. Compared with term born children, there was increased risk of most developmental disorders, particularly in the moderately preterm group, but also in late preterm and early term groups: the relative risk of cerebral palsy was, for 32 to 33 weeks: 14.1 (95% confidence intervals [CI]: 12.3-16.0), 34 to 36 weeks: 3.52 (95% CI: 3.16-3.92) and 37 to 38 weeks: 1.44 (95% CI: 1.32-1.58).

LIMITATIONS

Studies assessed children at different ages using varied criteria. The majority were from economically developed countries. All were published in English. Data were variably sparse; subgroup comparisons were sometimes based on single studies.

CONCLUSIONS

Children born moderately preterm are at increased risk of being diagnosed with or screening positive for developmental disorders compared with term born children. This association is also demonstrated in late preterm and early term groups but effect sizes are smaller.

Wide-field digital imaging system for assessing ocular anterior segment development in very preterm infants

Purpose

This study aims to longitudinally investigate developments of the anterior segment in very preterm infants who exhibit normal retinal development outcomes by utilizing a wide-field digital imaging system.

Methods

Between June 2021 and June 2022, neonates with a birth weight of <1500 g and/or a gestational age (GA) of less than 32 weeks were included in this study. The participants underwent regular ocular examinations, including sequential evaluations of the anterior segment and the retina, at intervals of 2-5 weeks, starting from birth and continuing until they reached a corrected GA of 48 weeks. Term neonates were selected as normal controls for the study. The study recorded the weight and GA of subjects at the time of examination, as well as indicators of abnormal development in the anterior segment.

Results

A total of 48 very preterm infants with normal retinal developmental outcomes were enrolled. The control group included 59 full-term infants. Common anterior segment eye abnormalities such as persistent hyperplasia of primary vitreous, persistent pupillary membranes, iris vessels, and anterior chamber angle vessels gradually subsided with the period in very preterm infants. The vascularity of the iris was substantially higher than in term controls (P < 0.05) at term gestation. The imaging of iris vessels and anterior chamber angle vessels in very preterm infants exhibited a decline at 46 and 47 weeks, respectively, which occurred slightly later compared to term infants.

Conclusion

In very preterm infant s with normal outcomes, although the developmental process is delayed, they may form a normal anterior segment structure similar to that of full-term infants in the late stages, which is followed up by the wide-field digital imaging system.

Longitudinal Analysis of Refractive Errors in Premature Children during the First Three Years of Life

PURPOSE

To examine the longitudinal behavior of refractive errors in both retinopathy of prematurity (ROP) and non-ROP screened premature children during the first three years of life.

METHODS

This retrospective cohort included premature children (less than 37 weeks gestational age) born between 10/2011 and 8/2013 with ≥ two cycloplegic refractions. Cycloplegic refractions were converted into power vectors: M (spherical equivalent), J₀ [positive for with-the-rule (WTR) and negative for against-the-rule (ATR) astigmatism], and J ₄₅ (oblique astigmatism). Each power vector component was fitted by multilevel mixed-effects linear regression models; the mean change over time was analyzed.

RESULTS

Mean J₀ was 0.59 (95% CI 0.53-0.66) at six months and 0.29 (95% CI 0.19-0.39) at 18 months; afterward, the change was <0.1 per year. J₀ decreased -0.32 (0.64 diopters) over three years. When analyzed in one-year increments, the mean change in J₀ and M was lowest at 24 months. M decreased 1.13 diopters over three years.

CONCLUSION

WTR astigmatism and spherical equivalent decreased over the first three years of life. WTR astigmatism accounted for the majority of amblyopogenic refractive errors. The change in J₀ leveled after 18 months and the lowest rate of change was at 24 months in J₀ and M, thus it may be appropriate to screen this high-risk population around 18-24 months.

Comparative study of visual dysfunctions in 6-10-year-old very preterm- and full-term-born children

PURPOSE

To compare visual dysfunction between very preterm-born (VPB) children with no retinopathy of prematurity (no-ROP) at 6-10 years of age and age- and sex-matched full-term-born controls.

METHODS

This is an observational, prospective study that included 30 children, 6-10 years of age, born ≤ 32 weeks of gestation, with no-ROP, and 30 age- and sex-matched full-term-born controls, conducted from January 2015 until August 2015. All children underwent complete ophthalmic evaluation. Main outcome measures include visual functions (best corrected visual acuity (BCVA), color vision, and stereoacuity), ocular alignment, refractive errors, and the presence of amblyopia and nystagmus.

RESULTS

Mean BCVA of the right eyes was 0.04 ± 0.08 logMAR for VPB children and 0.02 ± 0.05 logMAR for the full-term children (P = 0.075). Mean BCVA for the left eyes was 0.07 ± 0.09 logMAR for VPB children and 0.02 ± 0.05 logMAR for the full-term children (P = 0.014). Refractive errors were slightly higher though not statistically significant in VPB children compared to full-term children (P = 0.125). The incidence of myopia and hypermetropia was 16.7 and 40%, respectively, in VPB children and 10 and 23.3%, respectively, in full-term children. Anisometropia found only in VPB children with an incidence of 16.7%. Amblyopia found in 10% of VPB children compared to 3.3% in full-term children. Strabismus was found equally in 10% of each group.

CONCLUSION

VPB children with no-ROP are at an increased risk of developing decreased BCVA at least in one eye and anisometropia compared to age-matched full-term controls.