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Ophthalmologic Outcome of Extremely Preterm Infants at 6.5 Years of Age : Extremely Preterm Infants in Sweden Study (EXPRESS)

Hellgren, Kerstin M; Tornqvist, Kristina LU ; Jakobsson, Peter G; Lundgren, Pia; Carlsson, Birgitta; Källén, Karin LU ; Serenius, Fredrik; Hellström, Ann and Holmström, Gerd (2016) In JAMA Ophthalmology 134(5). p.555-562
Abstract

Importance: This follow-up study of extremely preterm (EPT) children (<27 weeks' gestational age [GA] at birth) revealed major eye and visual problems in 37.9% (147 of 388) of all EPT infants and in 55.4% (67 of 121) of the most immature subgroups at 6.5 years of age. These major eye and visual problems were strongly associated with treatment-requiring retinopathy of prematurity (ROP).

Objectives: To investigate the ophthalmologic outcome of a national cohort of EPT children at 6.5 years of age and to evaluate the impact of prematurity and ROP.

Design, Setting, and Participants: All surviving EPT children born in Sweden between April 1, 2004, and March 31, 2007, were included and compared with a matched term control... (More)

Importance: This follow-up study of extremely preterm (EPT) children (<27 weeks' gestational age [GA] at birth) revealed major eye and visual problems in 37.9% (147 of 388) of all EPT infants and in 55.4% (67 of 121) of the most immature subgroups at 6.5 years of age. These major eye and visual problems were strongly associated with treatment-requiring retinopathy of prematurity (ROP).

Objectives: To investigate the ophthalmologic outcome of a national cohort of EPT children at 6.5 years of age and to evaluate the impact of prematurity and ROP.

Design, Setting, and Participants: All surviving EPT children born in Sweden between April 1, 2004, and March 31, 2007, were included and compared with a matched term control group, as part of a prospective national follow-up study.

Main Outcomes and Measures: Visual acuity, refraction in cycloplegia, and manifest strabismus were evaluated and compared with GA at birth and with treatment-requiring ROP.

Results: The study cohort comprised 486 participants. The mean (SD) GA of the children who were included was 25 (1) weeks, and 45.7% (222 of 486) were female. At a median age of 6.6 years, 89.3% (434 of 486) of eligible EPT children were assessed and compared with 300 control group children. In the EPT group, 2.1% (9 of 434) were blind, 4.8% (21 of 434) were visually impaired according to the World Health Organization criteria, and 8.8% (38 of 434) were visually impaired according to the study criteria. Strabismus was found in 17.4% (68 of 390) and refractive errors in 29.7% (115 of 387) of the EPT children compared with 0% (0 of 299) and 5.9% (17 of 289), respectively, of the control children (P < .001). Altogether at 6.5 years of age, 37.9% (147 of 388) of the EPT children had some ophthalmologic abnormality compared with 6.2% (18 of 290) of the matched control group (95% CI of the difference, 26.1%-37.2%). When treatment-requiring ROP was adjusted for, no significant association between GA and visual impairment could be detected. For refractive errors, the association with GA remained after adjustment for treatment-requiring ROP (odds ratio, 0.72; 95% CI, 0.58-0.91 for each 1-week increment).

Conclusions and Relevance: In a Swedish national cohort of EPT children at 6.5 years of age, major eye and visual problems were frequently found. Treatment-requiring ROP was a stronger impact factor than GA on visual impairment and strabismus, but not on refractive errors, as a whole. In modern neonatal intensive care settings, ophthalmologic problems continue to account for a high proportion of long-term sequelae of prematurity.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
JAMA Ophthalmology
volume
134
issue
5
pages
555 - 562
publisher
American Medical Association
external identifiers
  • Scopus:84968884312
  • WOS:000375796100020
ISSN
2168-6165
DOI
10.1001/jamaophthalmol.2016.0391
language
English
LU publication?
yes
id
4ba4e7b3-8fbb-4732-a323-c08b6d7189e9
date added to LUP
2016-04-11 13:15:09
date last changed
2017-02-05 04:48:46
@article{4ba4e7b3-8fbb-4732-a323-c08b6d7189e9,
  abstract     = {<p>Importance: This follow-up study of extremely preterm (EPT) children (&lt;27 weeks' gestational age [GA] at birth) revealed major eye and visual problems in 37.9% (147 of 388) of all EPT infants and in 55.4% (67 of 121) of the most immature subgroups at 6.5 years of age. These major eye and visual problems were strongly associated with treatment-requiring retinopathy of prematurity (ROP).</p><p>Objectives: To investigate the ophthalmologic outcome of a national cohort of EPT children at 6.5 years of age and to evaluate the impact of prematurity and ROP.</p><p>Design, Setting, and Participants: All surviving EPT children born in Sweden between April 1, 2004, and March 31, 2007, were included and compared with a matched term control group, as part of a prospective national follow-up study.</p><p>Main Outcomes and Measures: Visual acuity, refraction in cycloplegia, and manifest strabismus were evaluated and compared with GA at birth and with treatment-requiring ROP.</p><p>Results: The study cohort comprised 486 participants. The mean (SD) GA of the children who were included was 25 (1) weeks, and 45.7% (222 of 486) were female. At a median age of 6.6 years, 89.3% (434 of 486) of eligible EPT children were assessed and compared with 300 control group children. In the EPT group, 2.1% (9 of 434) were blind, 4.8% (21 of 434) were visually impaired according to the World Health Organization criteria, and 8.8% (38 of 434) were visually impaired according to the study criteria. Strabismus was found in 17.4% (68 of 390) and refractive errors in 29.7% (115 of 387) of the EPT children compared with 0% (0 of 299) and 5.9% (17 of 289), respectively, of the control children (P &lt; .001). Altogether at 6.5 years of age, 37.9% (147 of 388) of the EPT children had some ophthalmologic abnormality compared with 6.2% (18 of 290) of the matched control group (95% CI of the difference, 26.1%-37.2%). When treatment-requiring ROP was adjusted for, no significant association between GA and visual impairment could be detected. For refractive errors, the association with GA remained after adjustment for treatment-requiring ROP (odds ratio, 0.72; 95% CI, 0.58-0.91 for each 1-week increment).</p><p>Conclusions and Relevance: In a Swedish national cohort of EPT children at 6.5 years of age, major eye and visual problems were frequently found. Treatment-requiring ROP was a stronger impact factor than GA on visual impairment and strabismus, but not on refractive errors, as a whole. In modern neonatal intensive care settings, ophthalmologic problems continue to account for a high proportion of long-term sequelae of prematurity.</p>},
  author       = {Hellgren, Kerstin M and Tornqvist, Kristina and Jakobsson, Peter G and Lundgren, Pia and Carlsson, Birgitta and Källén, Karin and Serenius, Fredrik and Hellström, Ann and Holmström, Gerd},
  issn         = {2168-6165},
  language     = {eng},
  month        = {03},
  number       = {5},
  pages        = {555--562},
  publisher    = {American Medical Association},
  series       = {JAMA Ophthalmology},
  title        = {Ophthalmologic Outcome of Extremely Preterm Infants at 6.5 Years of Age : Extremely Preterm Infants in Sweden Study (EXPRESS)},
  url          = {http://dx.doi.org/10.1001/jamaophthalmol.2016.0391},
  volume       = {134},
  year         = {2016},
}