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Disorders of vision in neonatal hypoxic-ischaemic encephalopathy: a systematic review
  1. Eva Nagy1,2,
  2. Jay Self3,
  3. Cathy Williams4,5,
  4. Brigitte Vollmer6
  1. 1 Faculty of Medicine, University of Southampton, Southampton, UK
  2. 2 Neonatal and Paediatric Neurology, Southampton General Hospital, Southampton, UK
  3. 3 Southampton Eye Unit, Southampton General Hospital, Southampton, UK
  4. 4 Ophthalmology, Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
  5. 5 Bristol Medical School, University of Bristol, Bristol, UK
  6. 6 Paediatric Neurosciences, University of Southampton/University Hospitals Southampton, Southampton, UK
  1. Correspondence to Eva Nagy, Faculty of Medicine, University of Southampton, Southampton SO17 1BJ, UK; en1g15{at}


Objective Neonatal hypoxic-ischaemic encephalopathy (HIE) following perinatal asphyxia in term infants is associated with neonatal mortality and a high risk of neurodevelopmental impairment later in life. Visual disorders are an accepted complication of HIE and the association has been cited in the literature many times. This review aims to study the evidence for this association and assess the quality of the data on which this is based.

Design A systematic literature review was conducted and 922 citations were assessed using standard methods outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol.

Results The results demonstrate that the majority of studies have reported on various neurodevelopmental outcomes but rarely specifically vision. Based on limited currently available data, extracted from a number of small studies, an association of neonatal HIE with visual impairments seems to exist but detail is lacking. Notably, in the existing studies, there is a striking lack of consistency in the methods used to diagnose HIE and, similarly, a wide variation in the methods employed to measure visual function.

Conclusions To explore the observed association further in terms of prognosis and the effects of HIE treatments on visual outcomes, future studies will need to address the issues of standardised diagnostic criteria, severity grading and robust, age-appropriate visual assessment.

  • neonatology
  • neurodevelopment
  • neurology
  • ophthalmology
  • paediatric practice

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  • Contributors Conception and design of the study was mainly carried out by BV and JS, and analysis of selected papers and research method was carried out by EN, with CW acting as a main reviewer as well.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. No new data were reported or analysed in this systematic review; therefore data sharing is not applicable.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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