Strabismus at Age 2 Years in Children Born Before 28 Weeks' Gestation: Antecedents and Correlates.
Children born very preterm are at greater risk of ophthalmic morbidities, including strabismus, than children born at term. We evaluated perinatal factors associated with strabismus at age 2 years in a large population of infants delivered before 28 weeks' gestation. A total of 996 infants in the multicenter ELGAN (Extremely Low Gestational Age Newborn) study who had a retinal exam in infancy and a developmental assessment at 2 years corrected age are included. Their mothers were interviewed about the pregnancy, and both mother and newborn charts were reviewed. Certified examiners administered the Bayley Scales of Infant Development-II and performed an examination of ocular alignment. Time-oriented logistic regression risk models were created to evaluate the associations of characteristics and exposures with the development of strabismus. Overall, 14% (n = 141) of the children had strabismus at 2 years, and 80% of strabismic children had esotropia. Characteristics associated with strabismus were birth before 26 weeks' gestation, severe fetal growth restriction, and maternal history of aspirin ingestion. Associated postnatal factors included a SNAP-II (Score for Neonatal Acute Physiology) illness severity value ≥ 30, brain ventriculomegaly, type I retinopathy of prematurity, and ventilator-dependent severe bronchopulmonary dysplasia. Strabismus in very preterm populations is associated with a number of antenatal and postnatal antecedents as well as clinical and imaging correlates indicative of brain damage in these children. Routine ophthalmologic assessments in the early years can allow appropriate and timely interventions.
Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA Deborah.vanderveen@childrens.harvard.edu.
Deborah K
DK
VanderVeen
Neuroepidemiology Unit, Boston Children's Hospital, Boston MA, USA Neurology, Harvard Medical School, Boston, MA, USA Biostatistics, Harvard School of Public Health, Boston, MA, USA.
Elizabeth N
EN
Allred
Department of Ophthalmology, Duke University Medical Center, Durham NC, USA.
David K
DK
Wallace
Neuroepidemiology Unit, Boston Children's Hospital, Boston MA, USA Neurology, Harvard Medical School, Boston, MA, USA.
Alan
A
Leviton
D002657:Child Development; D002675:Child, Preschool; D005260:Female; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D016015:Logistic Models; D016017:Odds Ratio; D011247:Pregnancy; D011297:Prenatal Exposure Delayed Effects; D012306:Risk; D013285:Strabismus / Q000453:epidemiology*
brain; development; preterm birth; retinopathy of prematurity; ventriculomegaly