Preemie Issues - a quick look

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Preterm infants are at greater risk for both short and long term difficulties. The tinier and earlier a preemie is born the greater the risk for complications.


Preemie Babies are not just tiny...

Premature babies are not just tiny; they are at risk for a number of health concerns, including breathing difficulties, brain injury, eye disorders, infection, bowel problems and heart dysfunction.
The issues surrounding preterm birth can be complex but we have tried to cover everything you may want to know. If you have any questions please ask them in our forums.

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Eye Problems in preemies

As is the case with other major organs of the body, being born too early can affect the normal development of the eye.

The retina, which is at the back of the eye and consists of specialised cells to detect visual images, is one of the last organs to develop blood vessels. Therefore the preemie infants eye can be at risk to damage.

preterm infants and retinopathy of prematurity ROP

Retinopathy of Prematurity

Retinopathy of prematurity is a disorder of the eye that preterm infants are most at risk for in the neonatal period. Retinopathy of prematurity (ROP) is a disease affecting the growth of blood vessels of the retina of preterm infants; it can be mild with no visual deficits, or it can be severe resulting in retinal detachment and blindness.

Retinopathy is a progressive disease and can evolve from mild ROP (stage 1) to moderate ROP (stage 2) to severe ROP (stage 3), that in some cases can develop a partial retinal detachment (stage 4), and then to a total retinal detachment, which results in profound loss of vision (stage 5).


Due to improved medical monitoring, sight-threatening ROP is relatively uncommon among infants of birth weight greater than 1000 g but is still a significant problem among infants of birth weights less than 750 g; it also remains the main cause of visual impairment in premature babies.

More than 50% of preterm infants weighing less than 1250 g at birth show evidence of ROP, and about 10% of these infants develop stage 3 ROP. Retinal detachment occurs and leads to visual loss in only a few percent of infants with stage 3 or more severe ROP, and in most cases, spontaneously regresses, meaning most cases improve without treatment.

Advances in the treatment of ROP have also contributed to better visual outcomes for preemies. For example, the removal of abnormal peripheral vessels with cryotherapy and laser therapy has led to favourable visual outcomes, persisting at least to 2 years of age.

Long-term Outcomes

ROP has been associated with unfavourable long-term outcomes in cognitive and academic domains in some follow-up research studies. The severity of ROP is more significantly associated with visual problems (ophthalmologic morbidity) such that stage 3 and 4 ROP are more likely to result in poor visual outcome than stage 1 or 2.

Long-term follow-up of children with ROP has shown that there is an increased incidence of strabismus, amblyopia and refractive errors. In particular the incidence of myopia, also called short-sightedness, in preterm children with ROP is higher compared with other preterm infants and infants born full term.

ROP has been associated with other developmental difficulties, such as organising visual information, gross motor skills, and lower eye-hand coordination.

Research Examples

  • One study reported that more than 50% of preterm children between 2 and 8 years of age who had ROP become myopic (short-sighted), compared with approximately 15% of preterm children without ROP.
  • Preterm children with ROP have higher rates of:
    • strabismus (23% versus 9%)
    • amblyopia (6% versus 1.4%)
    • myopia (50% versus 15%)
    • astigmatism
    • and anisometropia
    than other preterm children.

Other Facts about Preemies and ROP

  • The relationship between ROP and poor long-term visual outcome is complicated by the fact that those at greatest risk for ROP are also the sickest and smallest infants.
  • For example, ROP is also associated with gestational age, hyperoxia (excess oxygen), fluctuating oxygen levels, duration of mechanical ventilation, patent ductus arteriosus (PDA), and intraventricular haemorrhage (IVH).
  • Some of these factors have also been associated with poor visual outcome, so it is difficult to determine the actual cause of these impairments.
(Kushner, 1982; Madan, Jan, & Good, 2005; Nissenkorn, Yassur, Mashkowski, Sherf, & Ben-Sira, 1983; Quinn et al., 1998; Snir, Nissenkorn, Sherf, Cohen, & Ben Sira, 1988) (Bohm et al., 2002; Csak, Szabo, Szabo, & Vannay, 2006; Darlow, Clemett, Horwood, & Mogridge, 1997; Erikson, Allert, Carlberg, & Katz-Salamon, 2003; Fleck & McIntosh, 2008; Good, 2006; Goyen et al., 2006; The International Classification of Retinopathy of Prematurity revisited," 2005; Purohit, Ellison, Zierler, Miettinen, & Nadas, 1985; Saito et al., 1993; Todd, Kennedy, Roberts, & John, 1990; Watts & Adams, 2000; Watts, Adams, Thomas, & Bunce, 2000)


Technical Reference List

Bohm, B., Katz-Salamon, M., Institute, K., Smedler, A.-C., Lagercrantz, H., & Forssberg, H. (2002). Developmental risks and protective factors for influencing cognitive outcome at 5 1/2 years of age in very-low-birthweight children. Developmental Medicine and Child Neurology, 44(8), 508-516. Csak, K., Szabo, V., Szabo, A., & Vannay, A. (2006). Pathogenesis and genetic basis for retinopathy of prematurity. Front Biosci, 11, 908-920. Darlow, B. A., Clemett, R. S., Horwood, L. J., & Mogridge, N. (1997). Prospective study of New Zealand infants with birth weight less than 1500 g and screened for retinopathy of prematurity: visual outcome at age 7-8 years. British Journal of Ophthalmology, 81(11), 935-940. Erikson, C., Allert, C., Carlberg, E. B., & Katz-Salamon, M. (2003). Stability of longitudinal motor development in very low birthweight infants from 5 months to 5.5 years. Acta Paediatrica, 92(2), 197-203. Fleck, B. W., & McIntosh, N. (2008). Pathogenesis of retinopathy of prematurity and possible preventive strategies. Early Hum Dev, 84(2), 83-88. Good, W. V. (2006). The Early Treatment for Retinopathy Of Prematurity Study: structural findings at age 2 years. Br J Ophthalmol, 90(11), 1378-1382. Goyen, T. A., Todd, D. A., Veddovi, M., Wright, A. L., Flaherty, M., & Kennedy, J. (2006). Eye-hand co-ordination skills in very preterm infants <29 weeks gestation at 3 years: Effects of preterm birth and retinopathy of prematurity. Early Human Development, 82(11), 739-745. The International Classification of Retinopathy of Prematurity revisited. (2005). Archives of Ophthalmology, 123(7), 991-999. Kushner, B. J. (1982). Strabismus and amblyopia associated with regressed retinopathy of prematurity. Archives of Ophthalmology, 100(2), 256-261. Madan, A., Jan, J. E., & Good, W. V. (2005). Visual development in preterm infants. Developmental Medicine and Child Neurology, 47(4), 276-280. Nissenkorn, I., Yassur, Y., Mashkowski, D., Sherf, I., & Ben-Sira, I. (1983). Myopia in premature babies with and without retinopathy of prematurity. British Journal of Ophthalmology, 67(3), 170-173. Purohit, D. M., Ellison, R. C., Zierler, S., Miettinen, O. S., & Nadas, A. S. (1985). Risk factors for retrolental fibroplasia: experience with 3,025 premature infants. National Collaborative Study on Patent Ductus Arteriosus in Premature Infants. Pediatrics, 76(3), 339-344. Quinn, G. E., Dobson, V., Kivlin, J., Kaufman, L. M., Repka, M. X., Reynolds, J. D., et al. (1998). Prevalence of myopia between 3 months and 5 1/2 years in preterm infants with and without retinopathy of prematurity. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology, 105(7), 1292-1300. Saito, Y., Omoto, T., Cho, Y., Hatsukawa, Y., Fujimura, M., & Takeuchi, T. (1993). The progression of retinopathy of prematurity and fluctuation in blood gas tension. Graefes Archive for Clinical and Experimental Ophthalmology, 231(3), 151-156. Snir, M., Nissenkorn, I., Sherf, I., Cohen, S., & Ben Sira, I. (1988). Visual acuity, strabismus, and amblyopia in premature babies with and without retinopathy of prematurity. Annals of Ophthalmology, 20(7), 256-258. Todd, D., Kennedy, J., Roberts, V., & John, E. (1990). Risk factors in progression beyond stage 2 retinopathy of prematurity. Australian and New Zealand Journal of Ophthalmology, 18(1), 57-60. Watts, P., & Adams, G. G. (2000). In vitro fertilisation and stage 3 retinopathy of prematurity. Eye, 14 ( Pt 3A), 330-333. Watts, P., Adams, G. G., Thomas, R. M., & Bunce, C. (2000). Intraventricular haemorrhage and stage 3 retinopathy of prematurity. British Journal of Ophthalmology, 84(6), 596-599.



AlbertEinstein_iconOne of the greatest minds in history, Albert Einstein was born preterm.

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Preemie, Premmie, or Prem?

Most babies spend between 38 and 42 weeks in their mother’s uterus. So, technically a preterm birth, preemie, premmie, or prem, is an infant who is born less than 37 completed gestational weeks. 

Read More: Defining Preterm birth



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