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Improving neurodevelopmental trajectories after retinopathy of prematurity: challenges and opportunities

Pediatric Research volume 94, pages 1598–1599 (2023)Cite this article

Important advances in neonatology have included efforts to reduce major morbidities impacting on the developmental lung, brain, eye, gastrointestinal, and immunological systems. These major morbidities include bronchopulmonary dysplasia, sonographic gray and white matter injury, retinopathy of prematurity (ROP), necrotizing enterocolitis, and postnatal sepsis. More than two decades ago, Schmidt and colleagues demonstrated in a pharmacological trial to reduce intraventricular hemorrhage in very preterm infants that severe ROP, bronchopulmonary dysplasia, and severe sonographic abnormalities of intraventricular hemorrhage grade III/IV, cystic periventricular leukomalacia, or ventriculomegaly substantially increased neurodevelopmental disabilities at age 24 months.1 Specifically, they found that if extremely preterm infants had all three of these morbidities then the risk for death or neurodevelopmental disability at 24 months was 88%. Subsequently, Canadian, Australian, and European investigators found that counts of these morbidities also impacted on 5- and 11-year disability outcomes.2,3,4

The long-term follow-up of infants in the randomized controlled trial (RCT) CRYO-ROP cohort at 5.5 years found that as severity of ROP increased, prevalence of motor, manipulative, self-care, and communicative disabilities increased.5 Major advances in neonatology have occurred since these two pioneering studies.6,7,8 A key question has remained about the relationship of grades of ROP not requiring laser surgery for retinal ablation or use of bevacizumab to limit proliferative vascular angiogenesis.9,10,11,12 It is in this respect that the paper by Brumbaugh and colleagues as part of the NICHD Neonatal Research Network is important.13

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Acknowledgements

M.E.M. is cochair of the Medical Round Table Scientific Advisory Committee of Pathways Inc., a not-for-profit organization that promotes parent–professional partnerships in the early detection of neruodevelopmental delays.

Funding

M.E.M. is supported in part by T73 MC11047 HRSA LEND-Leadership Education in Neurodevelopmental Disabilities, NR003695 NINR Risk and Protection in Trajectories of Preterm Infants: Birth-Adult, UG3 OD023348 NICHD Environmental Influences on Child Health Outcomes(ECHO) Consortium: Environment, Epigenetics, Neurodevelopment & Health of ELGANS NIH R01/NI NR018147-01 Allostatic Load & Epigenetic Mechanisms in Lifecourse Trajectories of Premature Infants at Age 30; NICHD R01 Microbiome and developmental trajectories in preterm infants and MCH UCLA Lifecourse Intervention Research Network Planning Grant entitled “Engaging Families of Preterm Babies to Optimize Thriving and Well-Being over the first 5 years of life.”

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  1. University of Chicago Kennedy Research Center on Intellectual and Neurodevelopmental Disabilities, 950 East 61st Street Room 207, Chicago, IL, 60637, USA

    Michael E. Msall

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Correspondence to Michael E. Msall.

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Msall, M.E. Improving neurodevelopmental trajectories after retinopathy of prematurity: challenges and opportunities. Pediatr Res 94, 1598–1599 (2023). https://doi.org/10.1038/s41390-022-02019-6

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