Retinopathy of Prematurity and Risk of Structural Brain Abnormalities on Magnetic Resonance Imaging at Term Among Infants Born at Less Than or Equal to 32 Weeks of Gestation.

Abstract

To determine if retinopathy of prematurity (ROP) is associated with brain abnormalities on structural magnetic resonance imaging at term-equivalent age in infants born preterm. We prospectively recruited 395 infants born preterm born at ≤32 weeks of gestation from 5 regional Cincinnati neonatal intensive care units. Eligible infants underwent routine ROP screening and diagnosis per international screening guidelines at 31 weeks postmenstrual age or 5-6 weeks of age (whichever came later). We obtained nonsedated structural magnetic resonance imaging at 39-44 weeks postmenstrual age. Brain injury/maturational abnormality was quantified using the validated Kidokoro global brain abnormality score by a single neuroradiologist. We performed multiple linear regressions to determine the association between ROP and brain abnormality score while adjusting for several known confounders. Of the regional sample of 395 infants born preterm, 134 (33.9%) developed ROP. Among those infants with ROP, 19 (14.2%) developed severe ROP (stage 3 or requiring treatment). In multiple linear regression analyses, ROP (any severity) (β = 1.5 [95% CI: 0.3, 2.8]) and severe ROP (β = 2.3 [0.1, 4.5]) remained significantly associated with global brain abnormality score, independent of multiple confounders. In secondary analyses, ROP was significantly associated with cerebellar and deep nuclear gray matter but not white matter or cortical gray matter abnormalities. In our regional cohort of infants born preterm, ROP, especially severe ROP, was significantly associated with global brain abnormalities at term. Such abnormalities are likely the structural correlates of later functional visual and neurodevelopmental impairments commonly attributed to ROP diagnosis.