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PEDIATRICS Vol. 113 No. 4 April 2004, pp. 790-799

Educational and Social Competencies at 8 Years in Children With Threshold Retinopathy of Prematurity in the CRYO-ROP Multicenter Study

Michael E. Msall, MD^*, Dale L. Phelps, MD, Robert J. Hardy, PhD, Velma Dobson, PhD^||, Graham E. Quinn, MD^¶, C. Gail Summers, MD^#, Michelle R. Tremont, MA^** for the Cryotherapy for Retinopathy of Prematurity Cooperative Group

^* Pritzker School of Medicine, University of Chicago, Comer Children’s and La Rabida Children’s Hospitals, Chicago, Illinois
Golisano Children’s Hospital at Strong, University of Rochester, Rochester, New York
University of Texas Health Science Center, Coordinating Center for Clinical Trials, Houston, Texas
^|| University of Arizona, Tucson, Arizona
^¶ Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
^# University of Minnesota, Minneapolis, Minnesota
^** Providence, Rhode Island

Objective. To describe the educational status and special education services at 8 years among children who had threshold retinopathy of prematurity (ROP).

Methods. A prospective study was conducted of a cohort of children who had birth weight of <1251 g and threshold ROP in the Cryotherapy for Retinopathy of Prematurity multicenter study. At age 5.5 years, visual status, functional skills, and social information were obtained. At 8 years, special education classes, developmental disabilities, rehabilitation therapies, and academic and social competencies were determined by questionnaire. Visual status was considered favorable/unfavorable on the basis of the better eye.

Results. Of 255 survivors, 216 (85%) were evaluated at both 5.5 and 8 years. Major impairments were significantly more prevalent in children with unfavorable versus favorable visual status: cerebral palsy (39% vs 16%), developmental disability (57% vs 22%), autism (9% vs 1%), and epilepsy (23% vs 3%). Special education services (63% vs 27%), below-grade-level academic performance (84% vs 48%), and school-based rehabilitation services were significantly less common in children with favorable visual status. Favorable visual status, favorable functional ratings at 5.5 years, markers of higher socioeconomic status, and nonblack race were associated with significantly lower rates of both special education placement and below-grade-level academic performance at age 8. On multivariate logistic regression, only favorable visual status and functional status remained significant predictors for decreasing special education placement.

Conclusion. Threshold ROP is associated with high rates of developmental, educational, and social challenges in middle childhood; preserved vision was associated with a clear advantage, with more than half of the children with favorable visual status performing at grade level.

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Key Words: very low birth weight • developmental disabilities • retinopathy of prematurity • long-term follow-up • special education

Abbreviations: ELBW, extremely low birth weight • VLBW, very low birth weight • CRYO-ROP, Cryotherapy for Retinopathy of Prematurity • ROP, retinopathy of prematurity • WeeFIM, Functional Independence Measure for Children • SD, standard deviation • CI, confidence interval • RR, relative risk

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Received for publication Feb 3, 2003; Accepted Oct 28, 2003.

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