Evaluation of Optic Nerve Development in Preterm and Term Infants Using Handheld Spectral-Domain Optical Coherence Tomography

Abstract

Purpose Evaluate effects of prematurity on early optic nerve (ON) development and potential utility of ON parameters as indicators of central nervous system (CNS) development and pathology. Design Prospective cross-sectional and longitudinal study. Participants and Controls Forty-four preterm infants undergoing retinopathy of prematurity (ROP) screening and fifty-two term infants. Methods We analyzed optic nerves from portable handheld spectral domain optical coherence tomography (SDOCT) images (Bioptigen Inc., Research Triangle Park, NC) of 44 preterm and 52 term infants. The highest quality ON scan from either eye was selected for quantitative analysis. Longitudinal analysis was performed at both 31–36 and 37–42 weeks postmenstrual age (PMA). Preterm ON parameters were also assessed for correlation with indicators of cognitive, language and motor development, and CNS pathology. Main Outcome Measures Vertical cup diameter (vCupDiam), disc diameter (vDiscDiam), cup-to-disc ratio (vC:D), cup depth, and indicators of neuro-cognitive development and CNS pathology. Results At 37–42 weeks PMA, preterm infants had larger vCupDiam and vC:D than term infants (908 vs. 700 μm, p<0.001; 0.68 vs. 0.53 μm, p<0.001), while cup depth and vDiscDiam were not significantly different. Longitudinal changes (n=26 preterm eyes, mean interval 4.7 weeks) in vDiscDiam and in vC:D were an increase of 74 μm (p=0.008) and decrease of 0.05 (p=0.015), respectively. In preterm infants (n=44), periventricular leukomalacia was associated with larger vCupDiam (1084 vs. 828 μm, p=0.005) and vC:D (0.85 vs. 0.63, p<0.001), post-hemorrhagic hydrocephalus was associated with shallower cup (331 vs. 456 μm, p=0.030), and clinical magnetic resonance imaging (MRI) was associated with larger vC:D (0.73 vs. 0.64, p=0.023). In 23 preterm infants with Bayley Scales of Infant Development scores, larger vC:D was associated with lower cognitive scores (p=0.049). Conclusions This is the first analysis of ON parameters in premature infants using SDOCT. It demonstrated that by age of “term birth,” vCupDiam and vC:D are larger in preterm infants who were screened for ROP than in term infants. In this prospective pilot study, ON parameters in these preterm infants appear to weakly associate with CNS pathology and future cognitive development. Future prospective studies with larger numbers are necessary before further conclusions can be made.

Efeitos da prematuridade na aquisição da linguagem e na maturação auditiva: revisão sistemática

“…However, the study suggests that gestational age, low weight at birth and gender may be more influential in the long term in these children, thus being necessary to monitor this population -as has been observed in other studies reviewed (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) . These results evidenced the importance of monitoring these children from birth, although none of them followed-up on psychological factors such as those proposed by Kupfer et al (39) , indicated as closely related to language acquisition (40) .…”

“…When infants who suffered from retinopathy of prematurity were observed, one study found that premature infants with retinopathy at different levels had no association between hearing and speech scores at 3 years old on the Griffiths Mental Development Scales, but male infants with lower gestational age and low birth weight showed lower language performance (23) . Additionally, another study (20) did not find association between language scores on the Bayley Scales at 18 and 22 months old with other conditions related to the optical nerve. Three studies (13,24,26) investigated the association between language scores and white matter abnormalities in the neonatal period.…”

“…In contrast, two studies (20)(21)(22)(23) found no association of retinopathy of prematurity with language outcomes. However, the study suggests that gestational age, low weight at birth and gender may be more influential in the long term in these children, thus being necessary to monitor this population -as has been observed in other studies reviewed (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) .…”

“…Some of the studies verified impairments related to language outcomes in premature children, these having presented compromised language in relation to full-term children (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) . A study (19) also found association with hearing impairment.…”

“…The studies selected were divided into works that aimed to assess the effects and risks of the association of abnormalities and other aspects of development with prematurity. In these, assessments of language and hearing were part of the procedures to carry out such studies in a complementary basis (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) . On the other hand, other studies found focused mainly on language and/or hearing impairments in premature infants (28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) .…”