title: Effect of gestational age and birth weight on the risk of strabismus among premature infants.
abstract: OBJECTIVE
  Strabismus causes irreversible vision loss if not detected and treated early. It is unclear whether birth weight (BW) and gestational age (GA) are risk factors for strabismus.
  
  
  OBJECTIVE
  To estimate the effect of BW and GA on the likelihood of premature infants developing strabismus.
  
  
  METHODS
  In this longitudinal cohort analysis, we monitored a group of premature children from birth to determine the proportion that developed strabismus and the timing of the first strabismus diagnosis. Multivariable Cox regression analyses assessed the relationships of BW and GA with the development of strabismus. Regression models were adjusted for other risk factors for strabismus, sociodemographic factors, and ocular comorbidities. The analysis included 38,055 otherwise healthy children born prematurely who were enrolled for more than 6 months in a nationwide US managed care network between 2001 and 2011 in communities throughout the United States.
  
  
  METHODS
  Birth weight less than 2000 g or GA of 32 weeks or less.
  
  
  METHODS
  Hazard ratios (HRs) for strabismus with 95% CIs.
  
  
  RESULTS
  Of 38,055 otherwise healthy children who were born prematurely, 583 received a diagnosis of strabismus later in life. The cumulative incidence of strabismus was 3.0% at 5 years. Controlling for GA and other covariates, infants born with BW less than 2000 g had a 61% increased hazard (HR, 1.61; 95% CI, 1.22-2.13) of developing strabismus. Controlling for BW and other covariates, there was no significant association between strabismus and GA (HR, 0.98; 95% CI, 0.69-1.38). Among premature infants with BW of less than 2000 g, a GA of 32 weeks or less conveyed no additional increased risk for developing strabismus relative to infants born after 32 weeks (HR, 1.27; 95% CI, 0.86-1.88). In contrast, among infants with a GA of 32 weeks or less, BW of less than 2000 g conveyed a 14-fold increase in the risk of strabismus relative to BW of 2000 g or more (HR, 14.39; 95% CI, 1.99-104.14).
  
  
  CONCLUSIONS
  Independent of GA, very low BW conferred a large increase in strabismus risk among premature infants. In contrast, independent of BW, GA did not significantly affect the risk of strabismus. Updates to existing guidelines in the pediatric and ophthalmic literature should be considered, highlighting the importance of BW rather than GA and alerting clinicians about the need for careful monitoring of premature infants with low BW for strabismus.
authors.affiliation: W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
authors.forename: Shilpa
authors.initials: S
authors.lastname: Gulati
authors.affiliation: W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
authors.forename: Chris A
authors.initials: CA
authors.lastname: Andrews
authors.affiliation: W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
authors.forename: Alexandra O
authors.initials: AO
authors.lastname: Apkarian
authors.affiliation: W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
authors.forename: David C
authors.initials: DC
authors.lastname: Musch
authors.affiliation: W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
authors.forename: Paul P
authors.initials: PP
authors.lastname: Lee
authors.affiliation: W.K. Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D001724:Birth Weight; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000453:epidemiology* / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D012044:Regression Analysis; D012307:Risk Factors; D013285:Strabismus / Q000453:epidemiology* / Q000209:etiology; D014481:United States; D055815:Young Adult