Pre-term infants with severe retinopathy more likely to have non-visual disabilities

In a group of very low-birth-weight infants, severe retinopathy of prematurity was associated with nonvisual disabilities at age 5 years, according to a study in the February 5 issue of JAMA.

Severe retinopathy (disease of the retina) of prematurity occurs in premature infants treated with excessive concentrations of oxygen and is a serious complication of neonatal intensive care for preterm infants. "Although the incidence of severe retinopathy has increased since the late 1980s, blindness caused by retinopathy has become rare in developed countries. Consequently, clinicians and parents may conclude that severe retinopathy is no longer associated with childhood impairments," according to background information in the article.

Barbara Schmidt, M.D., M.Sc., of Children's Hospital of Philadelphia, and colleagues investigated whether infants with severe retinopathy retain an increased risk of nonvisual disabilities compared with those without severe retinopathy. This analysis (using data from a trial, Caffeine for Apnea of Prematurity), included infants with birth weights between 1.1 and 2.8 lbs. who were born between 1999 and 2004 and followed-up at age 5 years (2005-2011).

Of 1,815 eligible infants, 1,582 (87 percent) had complete (n = 1,523) or partial (n = 59) 5-year assessments. Of 95 with severe retinopathy, 40 percent had at least 1 nonvisual disability at 5 years compared with 16 percent of children without it. Fourteen of 94 children (15 percent) with and 36 of 1,487 children (2.4 percent) without severe retinopathy had more than 1 nonvisual disability. Motor impairment, cognitive impairment, and severe hearing loss were 3 to 4 times more common in children with severe retinopathy than those without severe retinopathy.

The authors write that these findings may help improve the ability to counsel parents and to select high-risk infants for long-term follow-up.

"Severe retinopathy of prematurity remains an adverse outcome of neonatal intensive care with poor prognosis for child development, although blindness can mostly be prevented by timely retinal therapy."