Objective To investigate the neurodevelopmental prognosis of premature infants with severe retinopathy of prematurity (ROP), and to assess whether ROP is associated with neurodevelopmental delay, so as to provide evidence for early identification and intervention. Methods A retrospective cohort study was conducted to analyze premature infants with a gestational age of 25 - 32 weeks admitted to the Children's Hospital Affliated to Zhengzhou University from January 1, 2019 to August 31,2021. Infants with severe ROP were assigned to the ROP group, while those with similar gestational ages but without ROP served as the control group.The cranial magnetic resonance imaging (MRI) results of both groups were compared at corrected full-term age, 3 months, and 6 months of corrected age. The Neonatal Behavioral Neurological Assessment (NBNA) scores at corrected full-term age, and the mental development index (MDI) and psychomotor development index (PDI) outcomes at 3, 6, 12, 18, and 24 months of corrected age were statistically analyzed. Results At 18 and 24 months of corrected age, the MDI and PDI scores of the ROP group were lower than those of the control group (MDI: t=2.344, 2.529, P<0.05; PDI: t=2.043, 2.378, P<0.05).The incidence of visual abnormalities (primarily ametropia) was significantly higher in the ROP group compared to the control group at the same time points (χ2=9.297, P=0.002).Logistic regression analysis revealed that oxygen therapy duration was a risk factor for later psychomotor developmental delay (OR=1.031, 95%CI: 1.005 - 1.058, P=0.021). Conclusions After treatment, visual impairment in premature infants with severe ROP is primarily manifested as refractive errors.At 18 - 24 months of corrected age, their MDI and PDI scores lag behind those of age-matched premature infants without ROP. Further research is recommended to investigate whether older children with ROP experience neurodevelopmental delays compared to preterm infants with the same age.
Key words
retinopathy of prematurity /
neurodevelopment /
vision /
hearing
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Sabri K, Ells AL, Lee EY, et al. Retinopathy of prematurity: A global perspective and recent developments[J].Pediatrics,2022,150(3): e2021053924.
[2] Wu T, Zhang L, Tong Y, et al. Retinopathy of prematurity among very low-birth-weight infants in China:Incidence and perinatal risk factors[J]. Invest Ophthalmol Vis Sci, 2018, 59(2): 757-763.
[3] Dammann O, Hartnett ME, Stahl A. Retinopathy of prematurity[J]. Dev Med Child Neurol, 2023, 65(5): 625-631.
[4] Godugu S, Vudugula SA, Neupane B, et al. Association between severe retinopathy of prematurity(ROP) and poor motor neurodevelopmental outcome[J]. Indian J Ophthalmol, 2023, 71(8): 2944-2946.
[5] 中华医学会眼科学分会眼底病学组. 中国早产儿视网膜病变筛查指南(2014年)[J]. 中华眼科杂志, 2014, 50(12): 933-935.
Fundus Disease Group of the Ophthalmology Branch of the Chinese Medical Association. Chinese guidelines for screening retinopathy in premature infants (2014)[J]. Chin J Ophthalmol, 2014, 50 (12): 933-935. (in Chinese)
[6] Palmer EA. Results of U.S. randomized clinical trial of cryotherapy for ROP (CRYO-ROP)[J]. Doc Ophthalmol, 1990, 74(3): 245-251.
[7] 国家卫生健康委办公厅. 国家卫生健康委办公厅关于印发 0～6岁儿童眼保健及视力检查服务规范(试行)的通知[EB/OL]. (2021-6-17). https://www.gov.cn/zhengce/zhengceku/2021-06/24/content_5620637.htm
[8] Haslam MD, Lisonkova S, Creighton D, et al. Severe neurodevelopmental impairment in neonates born preterm: Impact of varying definitions in a Canadian Cohort[J]. J Pediatr, 2018(197): 75-81.e4.
[9] Ahn SJ, Lee JY, Lee JY, et al. Brain white matter maturation and early developmental outcomes in preterm infants with retinopathy of prematurity[J]. Invest Ophthalmol Vis Sci, 2021, 62(2): 2.
[10] Huang CC, Chu CH, Lin YK, et al. Retinopathy of prematurity is a biomarker for pathological processes in the immature brain[J].Neonatology, 2022, 119(6): 727-734.
[11] Jacobson L, Vollmer B, Kistner A, et al. Severity of retinopathy of prematurity was associated with a higher risk of cerebral dysfunction in young adults born extremely preterm[J]. Acta paediatr, 2021, 110(2): 528-536.
[12] Romberg J, Wilke M, Allgaier C, et al. MRI-based brain volumes of preterm infants at term:A systematic review and meta-analysis[J]. Arch Dis Child Fetal Neonatal Ed, 2022, 107(5): 520-526.
[13] Rothman AL, Sevilla MB, Mangalesh S, et al. Thinner retinal nerve fiber layer in very preterm versus term infants and relationship to brain anatomy and neurodevelopment[J]. Am J Ophthalmol, 2015, 160(6): 1296-1308.e2.
[14] Gregorius J, Wang C, Stambouli O, et al. Small extracellular vesicles obtained from hypoxic mesenchymal stromal cells have unique characteristics that promote cerebral angiogenesis, brain remodeling and neurological recovery after focal cerebral ischemia in mice[J]. Basic Res Cardiol, 2021, 116(1): 40.
[15] Diggikar S, Gurumoorthy P, Trif P, et al. Retinopathy of prematurity and neurodevelopmental outcomes in preterm infants: A systematic review and meta-analysis[J].Front Pediatr,2023,11: 1055813.doi:10.3389/fped.2023.1055813
[16] Hennein L, Koo E, Robbins J, et al. Amblyopia risk factors in premature children in the first 3 years of life[J].J Pediatr Ophthalmol Strabismus, 2019, 56(2): 88-94.
[17] Kaya M, Berk AT, Yaman A. Long-term evaluation of refractive changes in eyes of preterm children: A 6-year follow-up study[J]. Int Ophthalmol, 2018, 38(4): 1681-1688.
[18] 杨佳洁,马继贤,田思雯,等. 早产儿视网膜病变干预治疗后屈光状态研究进展[J].眼科新进展, 2023, 43(6): 491-495.
Yang JJ, Ma JX, Tian SW, et al. Research progress on refractive status after intervention therapy for retinopathy in premature infants[J].Res Adv Ophthalmol, 2023, 43(6):491-495. (in Chinese)
PDF(968 KB)
