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

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@article{4ba4e7b38fbb4732a323c08b6d7189e9,
title = "Ophthalmologic Outcome of Extremely Preterm Infants at 6.5 Years of Age: Extremely Preterm Infants in Sweden Study (EXPRESS)",
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 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.",
author = "Hellgren, {Kerstin M} and Kristina Tornqvist and Jakobsson, {Peter G} and Pia Lundgren and Birgitta Carlsson and Karin K{\"a}ll{\'e}n and Fredrik Serenius and Ann Hellstr{\"o}m and Gerd Holmstr{\"o}m",
year = "2016",
doi = "10.1001/jamaophthalmol.2016.0391",
language = "English",
volume = "134",
pages = "555--562",
journal = "Archives of Ophthalmology",
issn = "0003-9950",
publisher = "American Medical Association",
number = "5",

}