Growth Trajectories During Early Childhood and Ocular Development in High-Risk Infants

Purpose: High-risk infants often show atypical postnatal growth and may be vulnerable to visual impairment, yet evidence linking early-life systemic growth with ocular development remains limited. This study investigated the associations between growth trajectories during early childhood (birth to 3 years) and ocular development in high-risk infants. Methods: In this population-based prospective study, 10,030 high-risk infants underwent repeated measurements of weight, length, body mass index (BMI), and head circumference from birth to 36 months. Growth velocities were calculated as changes in World Health Organization (WHO)-standardized z scores across developmental intervals. Uncorrected visual acuity (UCVA; logMAR) and cycloplegic spherical equivalent refraction (SER; diopters [D]) were assessed at 3 to 4 years. Associations between growth increments and ocular outcomes were examined using multivariable linear regression adjusting for demographic and perinatal factors. Results: Of the total, 36.6% were preterm, 6.9% were term low-birth-weight, and 31.7% were macrosomic. UCVA exhibited a graded pattern (P < 0.001): poorest in preterm infants (0.229 [0.224-0.234]), followed by term low-birth-weight (0.225 [0.215-0.235]) and term normal-birth-weight infants (0.219 [0.213-0.225]), whereas macrosomic infants showed comparable or slightly better UCVA (0.213 [0.207-0.219]). SER was most hyperopic among preterm infants (0.433 [0.410-0.456]) and least hyperopic among macrosomic infants (0.389 [0.360-0.419]). Accelerated growth during 0 to 6 and 6 to 12 months was consistently associated with poorer visual acuity and a more hyperopic refractive profile, with no significant associations observed beyond 12 months. Conclusions: Accelerated early-life growth was linked to less favorable visual acuity and refractive outcomes, highlighting the first postnatal year as a critical period for coordinated systemic and ocular development.