Upscaling Pediatrics

Approximately 32,300 infants worldwide are diagnosed with irreversible vision impairment due to ROP annually, of which approximately 20,000 become blind or severely visually impaired (1). Previous literature has identified severe retinopathy of prematurity (ROP) in neonates as a driving factor for neurodevelopmental impairment (NDI) – a disorder that ranges from mild motor and cognitive decay to severe cerebral palsy (2). But could socioeconomic factors also have a part to play? Researchers conducted a multicenter cohort study, consisting of 706 neonates (born at a gestational age of 30 weeks or less) screened for ROP in 2011 and 2022 (3).

Using electronic medical records and US Census Bureau income data, researchers found that infants screened for ROP with public health insurance were approximately four times more likely to experience worse neurodevelopmental outcomes in cognitive and language domains compared with their counterparts with private health insurance. Additionally, they were approximately three times more likely to develop worse neurodevelopmental outcomes in the motor domain. The results highlight the significant role of socioeconomic factors in the neurodevelopment of neonates. As a side note, the study also “supports the early neurodevelopmental safety of anti-VEGF treatment, as anti-VEGF therapy was not found to be independently associated with worse NDI in any domain,” write the authors.

Rather than simply being an issue with access to care, public health insurance status also points to systemic issues of financial instability, parental educational opportunities, race and ethnicity, and low familial support. According to the researchers, access to healthcare itself may, in turn, affect access to other resources, such as early childhood education, that may also impinge upon neurodevelopment.