602 - Early Screening for Cortical Visual Impairment in the NICU: Preliminary Findings from a Pilot Study

Publication Number: 3583.602

Amanda B. Deford, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, IN, United States; Heather J. Bruckman, Riley Hospital for Children at Indiana University Health, Martinsville, IN, United States; Sarah Wing, Indiana University School of Medicine, Indianapolis, IN, United States; Bittu Majmudar-Sheth, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Beatrice Stefanescu, Indiana University School of Medicine, Indianapolis, IN, United States

Background: Cortical Visual Impairment (CVI), which results from damage to neurologic pathways, is the leading cause of childhood blindness and low vision and affects about 1 in 30 children. The average age at the time of CVI diagnosis is 18 months, with many going undiagnosed for years. Delayed initiation of therapies may contribute to worse neurodevelopmental outcomes due to age-dependent visual neuroplasticity. The Neonatal Assessment Visual European Grid (NAVEG) screen has been suggested as a tool to help identify infants at the highest risk for CVI.

Objective: Primary objective: Evaluate feasibility and safety of NAVEG screening in neurocritical neonates.
Secondary objectives: Describe the incidence of abnormal NAVEG findings within specific high-risk populations and evaluate the screen's capacity for early CVI detection.

Design/Methods: This prospective cohort study enrolls infants admitted to a level IV NICU; completion expected by Spring 2026. Eligibility screening identifies infants at risk for CVI due to prematurity or neurologic diagnosis. Trained Occupational and Physical Therapists perform the bedside screen, which requires minimal tools and assesses ocular, motor, and perceptual visual function. The noninvasive screen takes ~15 minutes and a composite score of ≥6 is considered abnormal. Infants with abnormal results are referred for additional evaluation with specialized early intervention services, with outcomes collected. A one-year parental survey captures perceptions of the infants' visual function.

Results: Of 295 eligible infants, 135 were enrolled. 39% of screened infants had abnormal scores (Fig 1). The perceptual visual component was most often affected, and 33% of infants with abnormal scores had all three visual domains affected (Fig 2). There were no significant associations between baseline and demographic infant characteristics and risk classification (Table 1). Congenital hydrocephalus and intracranial hemorrhage were positively associated with increased odds of medium or high risk for CVI on the screening test (p=0.0020 and p=0.0297, respectively; Table 1). Overall, the implementation of NAVEG screening within the level IV NICU has been well received by providers, nurses, and families.

Conclusion(s): NAVEG screening has been feasible, well-received, and smoothly implemented. Abnormal results most often arise from the perceptual visual component. Congenital hydrocephalus and intracranial hemorrhage are significantly associated with abnormal scores. The outcomes of this study have potential to change the way CVI is identified and improve neurodevelopmental outcomes for at-risk neonates.

Figure 1
Study flowchart

Figure 2
Venn diagram of abnormal visual domains in the population screened

Table 1
Univariate logistic regression assessing predictors of NAVEG Low Risk vs Medium/High Risk