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Pediatr Neurol. 2014 Jul;51(1):36-42. doi: 10.1016/j.pediatrneurol.2014.03.007. Epub 2014 Mar 15.

Impaired visual fixation at the age of 2 years in children born before the twenty-eighth week of gestation. Antecedents and correlates in the multicenter ELGAN study.

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Department of Medicine, Stanford School of Medicine, Stanford, California.
Department of Pediatrics, Kennedy Research Center on Intellectual and Developmental Disabilities, University of Chicago Comer Children's Hospitals, Chicago, Illinois.
Department of Surgery, Michigan State University College of Human Medicine, Grand Rapids, Michigan.
Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
Department of Pediatrics, School of Medicine, Wake Forest University, Winston-Salem, North Carolina.
Department of Pediatrics, Boston Medical Center, Boston, Massachusetts.
Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts; Perinatal Neuroepidemiology Unit, Hannover Medical School, Hannover, Germany.
Department of Neurology, Boston Children's Hospital, Boston, Massachusetts. Electronic address:



Very little is known about the prevalence, antecedents, and correlates of impaired visual fixation in former very preterm newborns.


In the multicenter ELGAN study sample of 1057 infants born before the twenty-eighth week of gestation who had a developmental assessment at 2 years corrected age, we identified 73 who were unable to follow an object across the midline. We compared them to the 984 infants who could follow an object across the midline.


In this sample of very preterm newborns, those who had impaired visual fixation were much more likely than those without impaired visual fixation to have been born after the shortest of gestations (odds ratio, 3.2; 99% confidence interval, 1.4-7.5) and exposed to maternal aspirin (odds ratio, 5.2; 99% confidence interval, 2.2-12). They were also more likely than their peers to have had prethreshold retinopathy of prematurity (odds ratio, 4.1; 99% confidence interval, 1.8-9.0). At age 2 years, the children with impaired fixation were more likely than others to be unable to walk (even with assistance) (odds ratio, 7.5; 99% confidence interval, 2.2-26) and have a Mental Development Index more than three standard deviations below the mean of a normative sample (odds ratio, 3.6; 99% confidence interval, 1.4-8.2).


Risk factors for brain and retinal damages, such as very low gestational age, appear to be risk factors for impaired visual fixation. This inference is further supported by the co-occurrence at age 2 years of impaired visual fixation, inability to walk, and a very low Mental Development Index.


brain; developmental disabilities; preterm newborn; retinopathy of prematurity

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