(86) NAVEG: A Novel Screening Method for Cortical Visual Impairment in Neonates

Background: Cortical visual impairment (CVI), which results from damage to neurologic pathways, is the leading cause of childhood blindness and low vision.

Identification of CVI is often delayed by years, prolonging time to therapies. The Neonatal Assessment Visual European Grid (NAVEG) screen (Table 1) has been suggested as a tool to help identify the premature infants at highest risk for CVI. The feasibility and validity of NAVEG screening has not been evaluated among other high-risk populations prior to NICU discharge.

Objectives: Evaluate the feasibility of implementing NAVEG screening for at-risk neonates prior to NICU discharge; validate NAVEG tool for prediction of CVI in specific high-risk populations.

Design/Methods: This is an ongoing cohort study of infants admitted to a level IV NICU, with enrollment expected to be complete in fall 2025. Neonates are screened for eligibility by identification of risk factors for CVI including prematurity of < 32 weeks gestation, or other neurologic diagnoses. Enrolled neonates undergo NAVEG screening by trained examiners, consisting of ocular, motor, and perceptual visual components. Infants with abnormal results are referred for additional evaluation with specialized early intervention services. A one-year parental survey captures perceptions of the infants’ visual function.

Results: Of 292 eligible infants, 85 were enrolled. 39% of the screened infants had abnormal scores (Figure 1). The perceptual visual component was most often affected (Figure 2). There were no significant associations between baseline infant characteristics and screening risk classification (Table 2). In binary logistic regression, 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 2). Overall, the implementation of NAVEG screening within the level IV NICU has been well received by providers, nurses, and families.

Conclusions: The implementation of the NAVEG screening protocol has been shown to be feasible, well-received, and smoothly executed. The perceptual visual component was the most likely portion of the screen to elicit an abnormal score. Congenital hydrocephalus and intracranial hemorrhage have a statistically significant association with abnormal NAVEG score. The outcomes of this study have potential to change the way CVI is identified and improve outcomes for at-risk neonates.