White-Matter Injury is Associated With Impaired Gaze in Premature Infants

Glass, Hannah C.; Fujimoto, Shinji; Ceppi-Cozzio, Camilla; Bartha, Agnes I.; Vigneron, Daniel B.; Barkovich, A. James; Glidden, David V.; Ferriero, Donna M.; Miller, Steven P.

doi:10.1016/j.pediatrneurol.2007.08.019

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Volume 38, Issue 1 , Pages 10-15, January 2008

White-Matter Injury is Associated With Impaired Gaze in Premature Infants

Hannah C. Glass, MDCM
- Department of Neurology, University of California at San Francisco, San Francisco, California
- Department of Pediatrics, University of California at San Francisco, San Francisco, California
Shinji Fujimoto, MD
- Department of Neurology, University of California at San Francisco, San Francisco, California
Camilla Ceppi-Cozzio, MD
- Department of Neurology, University of California at San Francisco, San Francisco, California
Agnes I. Bartha, MD
- Department of Neurology, University of California at San Francisco, San Francisco, California
Daniel B. Vigneron, PhD
- Department of Radiology, University of California at San Francisco, San Francisco, California
A. James Barkovich, MD
- Department of Neurology, University of California at San Francisco, San Francisco, California
- Department of Radiology, University of California at San Francisco, San Francisco, California
- Department of Pediatrics, University of California at San Francisco, San Francisco, California
David V. Glidden, PhD
- Department of Epidemiology, University of California at San Francisco, San Francisco, California
Donna M. Ferriero, MD
- Department of Neurology, University of California at San Francisco, San Francisco, California
- Department of Pediatrics, University of California at San Francisco, San Francisco, California
Steven P. Miller, MDCM
- Department of Neurology, University of California at San Francisco, San Francisco, California
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
- Communications should be addressed to: Dr. Miller; Division of Neurology, K3-180; British Columbia Children’s Hospital, University of British Columbia; 4480 Oak St.; Vancouver, British Columbia V6H 3V4, Canada.

Received 13 February 2007; accepted 28 August 2007.

Periventricular leukomalacia is a risk factor for visual impairment in children born prematurely. The impact of diffuse white-matter injury, as detected on magnetic resonance imaging, on early visual function is unknown. We developed two 5-point visual-gaze scores to analyze the association between this clinical assessment and white-matter injury in 93 premature neonates <34 weeks of gestational age at birth. Older postmenstrual age was associated with higher values of the two gaze scores. Infants with moderate or severe white-matter injury had lower scores than their peers without white-matter injury (0.41 points, 95% confidence interval of 0.13-0.69 for visual fixation score; and 0.70 points, 95% confidence interval of 0.30-1.10 for conjugate score, P < 0.005). Using the results from both scales, a score of ≥9 in an infant examined at ≥36 weeks postmenstrual age predicted normal white matter on magnetic resonance examination, with a sensitivity of 84% and a specificity of 100%. These preliminary findings suggest that white-matter injury affects visual function even before term equivalent postmenstrual age.