Performance on 7 visual perceptual tasks at the age of 5, in relation to neonatal hemorrhagic-ischemic brain lesions

Purpose. It is well established by now that neonatal brain insult can cause visual acuity loss (Good et al 1994, Surv Ophthal 38: 351-364). This study investigates whether it can also give rise to higher visual perceptual deficits. Method. Four visual object identification tasks and three visuo-constructive tasks were administered to 41 children (age 5.02 to 5.89 yr), who were neonatally at risk due to prematurity or birth asphyxia. For each child neonatal ultrasound scans were used to judge whether he/she had suffered intracranial hemorrhage (ICH, N = 17), periventricular leukomalacia (PVL, N = 15), and/or white matter damage (WMD) as a consequence of either of these conditions (N = 9). Scans were normal in 14 children. Results. For each task the percentage of children performing at or below Pc 10 of same-age normal children was significantly above 10% (x2, range 27-49%). These high values can not be attributed to impaired visual acuity, since only mild impairments (14-19 c/deg) were found in four children. The frequency of performance at or below Pc 10 correlated significantly (φ-coefficient, x2) with WMD in six tasks, and with PVL in 4 tasks. ICH was not significantly related to performance on any of the 7 tasks. Conclusion. The results show that weak visual perceptual performance is more frequent in children who were neonatally at risk, than in normal children. The ultrasound condition most indicative of visual perceptual impairment is permanent damage to white matter, whereas intracranial hemorrhage is not related to it.