Retinopathy of prematurity and brain damage in the very preterm newborn

Abstract

Purpose To explain why very preterm newborns who develop retinopathy of prematurity (ROP) appear to be at increased risk of abnormalities of both brain structure and function. Methods A total of 1,085 children born at <28 weeks’ gestation had clinically indicated retinal examinations and had a developmental assessment at 2 years corrected age. Relationships between ROP categories and brain abnormalities were explored using logistic regression models with adjustment for potential confounders. Results The 173 children who had severe ROP, defined as prethreshold ROP (n = 146) or worse (n = 27) were somewhat more likely than their peers without ROP to have brain ultrasound lesions or cerebral palsy. They were approximately twice as likely to have very low Bayley Scales scores. After adjusting for risk factors common to both ROP and brain disorders, infants who developed severe ROP were at increased risk of low Bayley Scales only. Among children with prethreshold ROP, exposure to anesthesia was not associated with low Bayley Scales. Conclusions Some but not all of the association of ROP with brain disorders can be explained by common risk factors. Most of the increased risks of very low Bayley Scales associated with ROP are probably not a consequence of exposure to anesthetic agents.

Poorer Neurodevelopmental Outcomes Associated with Cystoid Macular Edema Identified in Preterm Infants in the Intensive Care Nursery

“…17 These findings suggest that there are neurologic deficits associated with ROP separate from visual acuity. In addition, Allred et al 34 found children with severe ROP were more likely to have scores on the second edition of Bayley Scales that were 2 to 3 standard deviations less than the expected mean score. They believe the preterm infant lacks growth factors, such as insulin-like growth factor 1, normally supplied by the mother in utero that protect against both retinal and brain damage.…”

“…29–31 Perinatal inflammation may contribute to CNS vulnerability or injury. 32–34 Alternately, cerebrovascular immaturity may play a role. 27 Cystoid macular edema within the retinal tissue may reflect cellular events that also are occurring in the CNS structures of the brain.…”

Extreme prematurity, treated retinopathy, bronchopulmonary dysplasia and cerebral palsy are significant risk factors for ophthalmological abnormalities at 6.5 years of age

“…Presumably, many postnatal risk factors are interrelated. For example, it has been suggested that the association between ROP and brain lesions might be explained by common risk factors .…”

Optical coherence tomography of the preterm eye: from retinopathy of prematurity to brain development

“…Interestingly, even those children with better visual acuity had functional deficits. Allred et al12 also observed that children with a history of severe ROP scored two to three standard deviations below the mean score on Bayley Scales of Infant and Toddler Development. This finding led to the hypothesis that preterm children may have reduced growth factors, such as insulin-like growth factor 1, which is critical for both brain and retinal development and usually supplied by the mother in utero.…”