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

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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; Jakobsson, Peter G; Lundgren, Pia; Carlsson, Birgitta; Källén, Karin; Serenius, Fredrik; Hellström, Ann; Holmström, Gerd.

In: JAMA Ophthalmology, Vol. 134, No. 5, 2016, p. 555-562.

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Hellgren, Kerstin M ; Tornqvist, Kristina ; Jakobsson, Peter G ; Lundgren, Pia ; Carlsson, Birgitta ; Källén, Karin ; Serenius, Fredrik ; Hellström, Ann ; Holmström, Gerd. / Ophthalmologic Outcome of Extremely Preterm Infants at 6.5 Years of Age : Extremely Preterm Infants in Sweden Study (EXPRESS). In: JAMA Ophthalmology. 2016 ; Vol. 134, No. 5. pp. 555-562.

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TY - JOUR

T1 - Ophthalmologic Outcome of Extremely Preterm Infants at 6.5 Years of Age

T2 - Extremely Preterm Infants in Sweden Study (EXPRESS)

AU - Hellgren, Kerstin M

AU - Tornqvist, Kristina

AU - Jakobsson, Peter G

AU - Lundgren, Pia

AU - Carlsson, Birgitta

AU - Källén, Karin

AU - Serenius, Fredrik

AU - Hellström, Ann

AU - Holmström, Gerd

PY - 2016

Y1 - 2016

N2 - 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.

AB - 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.

U2 - 10.1001/jamaophthalmol.2016.0391

DO - 10.1001/jamaophthalmol.2016.0391

M3 - Article

VL - 134

SP - 555

EP - 562

JO - Archives of Ophthalmology

JF - Archives of Ophthalmology

SN - 0003-9950

IS - 5

ER -