Cerebral/cortical visual impairment (CVI) is an important consequence of early brain injury, yet it is often recognized years after the neurological insult occurs. Many children at greatest risk—including infants with hypoxic-ischemic encephalopathy, prematurity, intraventricular hemorrhage, stroke, seizures, or other neurological injury—can already be identified during their NICU hospitalization. We therefore asked a simple question: could recognition of CVI risk begin in the NICU, before visual difficulties become apparent?

Our survey of NICU clinicians revealed an important gap between awareness and practice: providers recognized many CVI risk factors, but approaches to risk stratification, referral, follow-up, and conversations with families varied considerably. We used these findings to develop and implement a multidisciplinary, risk-based clinical pathway that identifies high-risk infants, supports family education, and facilitates appropriate visual follow-up after discharge. Rather than attempting to diagnose CVI in the NICU, our goal is to move recognition upstream—identifying risk early and building the follow-up pathway before infants leave the NICU.