Severity of neonatal retinopathy of prematurity is predictive of neurodevelopmental functional outcome at age 5.5 years

Objective. The purpose of this study was to assess the relation between neo natal 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 Mu lticenter Cryotherapy for Retinopathy of Prematurity Study. The extended na tural 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 cryothe rapy to not more than 1 eye. At 5.5 years both cohorts had ophthalmic and a cuity 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 histor y cohort; 87% had globally normal functional skills (WeeFIM: >95). As ROP s everity increased, rates of severe disability increased from 3.7% among tho se with no ROP, to 19.7% of those with threshold ROP. Multiple logistic reg ression analysis demonstrated that better functional status was associated with favorable visual acuity, favorable a-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 functiona l domain, the 134 children with favorable acuity in their better eye had fe wer disabilities than did the 82 children with unfavorable acuity: self-car e disability 25.4% versus 76.8%, continency disability 4.5% versus 50.0%, m otor disability 5.2% versus 42.7%, and communicative-social cognitive disab ility 22.4% versus 65.9%, respectively. Conclusion. Severity of neonatal ROP seems to be a marker for functional di sability at age 5.5 years among very low birth weight survivors. High rates of functional limitations in multiple domains occur in children who had th reshold ROP, particularly if they have unfavorable visual acuity.