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Shilpa Gulati, Chris Andrews, Alexandra Apkarian, David C Musch, Paul P Lee, Joshua D Stein; The Impact of Gestational Age and Birth Weight on the Risk of Strabismus among Premature Infants. Invest. Ophthalmol. Vis. Sci. 2014;55(13):4482.
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To estimate the impact of birth weight (BW) and gestational age (GA) on the likelihood of developing strabismus in premature infants.
We analyzed claims data of a large cohort of infants enrolled in a nationwide US managed care network between 2001 and 2011 who were born prematurely. Clinical Risk Groups (CRGs) were used to identify and exclude infants with chronic disease. ICD-9-CM billing codes were used to identify premature infants who developed strabismus. Multivariable Cox regression models assessed the relationships of BW and GA with the development of strabismus. Regression models were adjusted for available known risk factors for strabismus, sociodemographic factors, and ocular comorbidities.
Of 38 055 infants who were born prematurely, a cumulative total of 3.7% had developed strabismus at 6 years. Controlling for GA and other risk factors, infants born with BW < 2000g had a 61% increased hazard (adjusted HR=1.61; [CI 1.22-2.13]) of developing strabismus. Controlling for BW and other risk factors, there was no significant association between strabismus and GA (adjusted HR=0.98, [CI, 0.69-1.38]). Among premature infants with BW < 2000g, GA ≤ 32 weeks conveyed no additional increased risk for developing strabismus relative to those born after 32 weeks (adjusted HR=1.27, [CI, 0.86-1.88]). In contrast, among those with GA ≤ 32 weeks, BW < 2000g conveyed a 14-fold increase in the risk of strabismus relative to BW >2000g (adjusted HR=14.4, [CI 1.99-104]).
Independent of GA, BW < 2000g conferred a large increase in risk of strabismus among premature infants, especially among those with GA < 32 weeks. In contrast, independent of BW, GA did not significantly impact the risk of strabismus. Updates to existing guidelines in the ophthalmic and pediatric literature should be considered, highlighting the importance of BW rather than GA and alerting clinicians caring for premature infants about the need for careful monitoring of premature infants of low BW for strabismus.
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