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PEDIATRICS Vol. 106 No. 5 November 2000, pp. 998-1005

Severity of Neonatal Retinopathy of Prematurity Is Predictive of Neurodevelopmental Functional Outcome at Age 5.5 Years

Received Sept 21, 1999; accepted Mar 17, 2000.

Michael E. Msall*, Dale L. PhelpsDagger , Kathleen M. DiGaudio§, Velma Dobsonparallel , Betty Tung, Richard E. McClead#, Graham E. Quinn**, James D. ReynoldsDagger Dagger , Robert J. Hardy, Earl A. Palmer§§, and on Behalf of the Cryotherapy for Retinopathy of Prematurity Cooperative Group

From the * Child Development Center, Hasbro Children's Hospital, Brown University School of Medicine, Providence, Rhode Island; Dagger  Children's Hospital at Strong, University of Rochester, Rochester, New York; § Robert Warner Rehabilitation Center, Children's Hospital of Buffalo, State University of New York at Buffalo, Buffalo, New York; parallel  University of Arizona, Tucson, Arizona;  University of Texas Health Science Center, Coordinating Center for Clinical Trials, Houston, Texas; # Children's Hospital, Ohio State University, Columbus, Ohio; ** The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania; Dagger Dagger  Children's Hospital of Buffalo, State University of New York at Buffalo, Buffalo, New York; and §§ Casey Eye Institute, Oregon Health Sciences University, Portland, Oregon.

Objective.  The purpose of this study was to assess the relation between neonatal retinopathy of prematurity (ROP) in very low birth weight infants and neurodevelopmental function at age 5.5 years.

Methods.  Longitudinal follow-up of children occurred in 2 cohorts of the Multicenter Cryotherapy for Retinopathy of Prematurity Study. The extended natural history cohort followed 1199 survivors of <1251 g birth weight from 5 centers. The threshold randomized cohort (ThRz) followed 255 infants <1251 g from 23 centers who developed threshold ROP and who consented to cryotherapy to not more than 1 eye. At 5.5 years both cohorts had ophthalmic and acuity testing and neurodevelopmental functional status determined with the Functional Independence Measure for Children (WeeFIM).

Results.  Evaluations were completed on 88.7% of the extended natural history cohort; 87% had globally normal functional skills (WeeFIM: >95). As ROP severity increased, rates of severe disability increased from 3.7% among those with no ROP, to 19.7% of those with threshold ROP. Multiple logistic regression analysis demonstrated that better functional status was associated with favorable visual acuity, favorable 2-year neurological score, absence of threshold ROP, having private health insurance, and black race. Evaluations were completed on 87.4% of the ThRz children. In each functional domain, the 134 children with favorable acuity in their better eye had fewer disabilities than did the 82 children with unfavorable acuity: self-care disability 25.4% versus 76.8%, continency disability 4.5% versus 50.0%, motor disability 5.2% versus 42.7%, and communicative-social cognitive disability 22.4% versus 65.9%, respectively.

Conclusion.  Severity of neonatal ROP seems to be a marker for functional disability at age 5.5 years among very low birth weight survivors. High rates of functional limitations in multiple domains occur in children who had threshold ROP, particularly if they have unfavorable visual acuity.  Key words:  retinopathy of prematurity, very low birth weight, developmental outcomes, longitudinal studies, prematurity, blindness, vision disorders, developmental disabilities, functional independence.




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