RESUMEN

PURPOSE: There is uncertainty about the effect of increased neonatal protein intake on neurodevelopmental outcomes following preterm birth. The aim of this study was to assess the effect of a change in neonatal nutrition protocol at a major tertiary neonatal intensive care unit intended to increase protein intake on ophthalmic and visual development in school-age children born very preterm. METHODS: The study cohort comprised children (n = 128) with birthweight <1500 g or gestational age < 30 weeks born at Auckland City Hospital before (OldPro group, n = 55) and after (NewPro group, n = 73) a reformulation of parenteral nutrition that resulted in increased total protein intake during the first postnatal week and decreased carbohydrate, total parenteral fluid and sodium intake. Clinical and psychophysical vision assessments were completed at 7 years' corrected age, including visual acuity, global motion perception (a measure of dorsal stream function), stereoacuity, ocular motility and ocular health. Composite measures of favourable overall visual, binocular and functional visual outcomes along with individual vision measures were compared between the groups using logistic and linear regression models. RESULTS: Favourable overall visual outcome did not differ between the two groups. However, global motion perception was better in the NewPro group (p = 0.04), whereas the OldPro group were more likely to have favourable binocular visual outcomes (60% vs. 36%, p = 0.02) and passing stereoacuity (p = 0.02). CONCLUSIONS: These results indicate subtle but complex associations between early neonatal nutrition after very preterm birth and visual development at school age.

Asunto(s)

Recien Nacido Extremadamente Prematuro , Nacimiento Prematuro , Niño , Femenino , Recién Nacido , Humanos , Lactante , Agudeza Visual , Visión Ocular , Peso al Nacer , Recién Nacido de muy Bajo Peso

RESUMEN

The dichroic macular pigment in the Henle fiber layer in the fovea enables humans to perceive entoptic phenomena when viewing polarized blue light. In the standard case of linearly polarized stimuli, a faint bowtie-like pattern known as the Haidinger's brush appears in the central point of fixation. As the shape and clarity of the perceived signal is directly related to the health of the macula, Haidinger's brush has been used as a diagnostic marker in studies of early stage macular degeneration and central field visual dysfunction. However, due to the weak nature of the perceived signal the perception of the Haidinger's brush has not been integrated with modern clinical methods. Recent attempts have been made to increase the strength of the perceived signal by employing structured light with spatially varying polarization profiles. Here we review the advancements with the structured light stimuli and describe the current challenges and future prospects.