Infants with ROP and public health insurance were approximately four-times more likely to have worse neurodevelopmental outcomes in the cognitive and language domains as compared with their counterparts with private health insurance, and approximately four-times more likely to have worse neurodevelopmental outcomes in the motor domain. Photo: University of Iowa/www.eyerounds.org. Click image to enlarge.

It has been proposed that the association between neurodevelopmental impairment and retinopathy of prematurity (ROP) may be independent of visual outcomes and rather associated with the interruption of common pathways of both retinal and brain development in premature neonates. Researchers based out of the David Geffen School of Medicine at University of California, Los Angeles hypothesized that socioeconomic factors, including household income and insurance type, could be associated with adverse neurodevelopmental outcomes in a multicenter cohort of infants screened for ROP. The results of their study, published in JAMA Ophthalmology, revealed that public health insurance was associated with an increased risk of neurodevelopmental impairment in the cognitive, language and motor domains. The study also supported the early neurodevelopmental safety of anti-VEGF treatment, as anti-VEGF therapy was not found to be independently associated with worse neurodevelopmental impairment in any domain.

The retrospective cohort study used electronic medical records and US Census Bureau income data of 706 infants (mean age, 28.6 weeks; 53.1% male). Participants included infants who met American Academy of Pediatrics guidelines for ROP screening and had records from at least one Bayley Scales of Infant and Toddler Development neurodevelopment assessment between zero and 36 months of adjusted age.

Public health insurance was associated with a fourfold increased risk of moderate to severe neurodevelopmental impairment in cognitive and language domains (cognitive, odds ratio [OR]: 3.65; language, OR: 3.96) and a three-fold increased risk in the motor domain (motor, OR: 2.60). In this adjusted model, clinical factors that were associated with an increased risk of moderate to severe neurodevelopmental impairment included lower birth weight, diagnosis of intraventricular hemorrhage, male sex and older age at time of Bayley assessment.

In unadjusted analyses, infants who received either laser or anti-VEGF treatment, compared with infants without treatment-requiring ROP, had lower Bayley Scales of Infant and Toddler Development scores in multiple domains at 0 to 12 months, 12 to 24 months and 24 to 36 months. However, treatment type was no longer associated with worse neurodevelopmental outcomes in any domain in the multivariable model.

“Using a substantially larger, ethnically diverse cohort with over 700 infants in a multicenter approach, our study results further suggest the absence of an association between anti-VEGF treatment and adverse neurodevelopmental outcomes in infants with ROP,” the researchers wrote in their paper. “These findings are integral in further supporting the safety of anti-VEGF injections for ROP and in providing assurance to the relatively low risk of treatment.”

In this study, insurance type was the most influential risk factor on neurodevelopmental outcomes in this cohort of infants screened for ROP.  

“A neonate’s public health insurance status is reflective of a myriad of socioeconomic factors that likely in turn influence not only neonates’ access to not only health care but also to resources that may in turn affect their neurodevelopment, including access to early childhood education, long-term rehabilitation and therapy services, food security and familial support,” the researchers added.