‘Brain bleeds’ in infants may affect visual outcomes in their late elementary school years

Severe ‘brain haemorrhages’ suffered by some babies in the first year after birth lead to long-term vision problems, researchers from the University of Bristol, UK, have found in a ten-year follow-up study.

The study, published in the journal Developmental medicine and child neurology today [23 June]looked at 32 children who underwent detailed assessments at ages 10 to 11 after experiencing grade 3 or 4 intraventricular hemorrhage (brain bleeds) and ventricular dilatation (IVHVD) in a study called DRIFT10 .

The DRIFT10 study was set up to investigate a “brainwashing” technique for brain bleeding called DRIFT (Drainage, Irrigation and Fibrinolytic Therapy). DRIFT, developed by Bristol researchers, is the first and only treatment to objectively benefit infants with severe brain hemorrhage by washing out the ventricles of the brain to remove toxic fluids and reduce pressure.

The research team examined 32 children between the ages of 10 and 11. They investigated whether the level of IVHVD experienced as a baby affected their visual outcome at the end of their primary school years and explored the associations between visual outcomes with cognitive outcomes and with additional support for life. ‘school.

The eye exams were part of a ten-year follow-up study for children in the original DRIFT randomized trial. The testers followed a protocol and they did not know if the child had undergone IVHVD in grade 3 or 4 and all other data.

The study found that all 32 children assessed had at least one visual impairment. The average number of impairments per child was six for children with IVHVD in grade 4, compared to three for children with IVHVD in grade 3. Each additional visual impairment for each child was associated with increased educational support at school, after adjusting for developmental age equivalence.

These vision problems affecting children ten years later were often due to damage to the visual areas of the brain. These included problems moving the eyes precisely, detecting objects in the space around them, or visually matching the shapes or orientations of lines.

The children’s parents were unaware of these issues and generally said their children had normal vision as long as their glasses were worn.

However, the researchers found that for every additional sight problem a child had, they were more likely to receive additional support in their learning. This suggests that vision problems may have contributed to the learning difficulties experienced by this group of children.

Our research suggests that all children who suffer from brain bleeds or baby-like issues should have eye tests to identify brain-related vision problems as they grow, so that appropriate support can be offered. to see if it helps them.

Future researchers should be aware that parents who report normal vision may miss sight problems that are important to their children’s learning and development. »

Cathy Williams, study lead author and Professor of Pediatric Ophthalmology at Bristol Medical School: Population Health Sciences and Consultant in Pediatric Ophthalmology at University Hospitals Bristol and Weston NHS Foundation Trust (UHBW)


Journal reference:

Williams, C. et al. (2022) Visual function in children 10 years after grade 3 or 4 intraventricular hemorrhage with ventricular dilatation: a masked prospective study. Developmental medicine and child neurology. doi.org/10.1111/dmcn.15294.

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