604 - Bridging the Knowledge Gap: Awareness of Cerebral/Cortical Visual Impairment Among NICU Providers

Publication Number: 3585.604

Ceilidh Smith, Brigham and Women's Hospital, Boston, MA, United States; Hoda El-Shibiny, Brigham's Women Hospital, Boston, MA, United States; Lacey Smith, Perkins School for the Blind, Watertown, MA, United States; Carmina Erdei, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, United States; Gena Heidary, Boston Children's Hospital, Boston, MA, United States; Lotfi Merabet, Mass Eye & Ear, Harvard Medical School, Boston, MA, United States; Mohamed El-Dib, Brigham and Women's Hospital / Harvard Medical School, Boston, MA, United States

Background: Cerebral/cortical visual impairment (CVI) results from brain abnormalities that lead to deficits in visual function and impaired functional vision1. CVI is the leading cause of childhood blindness in developed countries. Risk factors of CVI in the neonatal period include hypoxic-ischemic encephalopathy, periventricular leukomalacia, stroke, and seizures1,2. While these risk factors are commonly diagnosed in the Neonatal Intensive Care Unit (NICU), counseling families of infants in the NICU regarding monitoring for CVI is not yet standard practice. This lack of anticipatory guidance has the potential to delay the diagnosis and management of CVI.

Objective: This survey aimed to assess the current baseline knowledge of CVI among various clinical providers in a single, academic level-III NICU.

Design/Methods: A detailed REDCap survey of 24 questions was created. The first 17 questions evaluated awareness, knowledge, confidence in discussing CVI with families, and interest in further education or guidelines. The remaining 7 questions, targeted to physicians, explored current practices for identifying and following at-risk infants, referral patterns, and perspectives on integrating standardized CVI risk guidelines into clinical care. (Box 1). We also asked for feedback on two vignettes representing infants with high risk for CVI. The survey link was distributed to providers including neonatal physicians, registered nurses, respiratory therapists, speech-language pathologists, occupational therapists, and physical therapists.

Results: Out of the 272 providers emailed, we received responses from 62 providers (61% nurses and 23% physicians). 41/ 62(66%) respondents affirmed that they knew the definition of CVI. When asked if they discuss CVI with families, most respondents (92%) answered 'no'. (Fig 1a) Among physicians, 8/14 (57%) of respondents described not knowing when to suspect an infant is at risk of CVI, and they all indicated the need for guidance on how to navigate conversations about CVI. (Fig 1b). Although most respondents identified the 2 vignettes as high risk, there was significant variation in the assessment of risk and in planning follow-up. (Example in Fig 2)

Conclusion(s): Our findings indicate that CVI remains insufficiently understood and largely overlooked by NICU providers, highlighting a clear need for enhanced provider education and guidance. Future work includes the development of a CVI clinical practice guideline for use in the NICU containing materials for staff and parent education, as well as a streamlined process for referring infants identified as having an increased risk of CVI.

Box 1. Summary of Survey Questions
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Figure 1a. Examples of survey responses from the whole cohort (n= 62); b. Examples of survey responses from physician cohort (n=14)


Figure 2. Example of case study responses from whole cohort (n=62)
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