Study of retinopathy of prematurity in neonates admitted to a neonatal intensive care unit: a prospective observational study

Abstract

Background: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the developing retina and a leading cause of preventable childhood blindness. With improving neonatal survival in resource-limited settings, the burden of ROP is rising. To determine the incidence and identify maternal and neonatal risk factors of ROP in neonates admitted to a tertiary care neonatal intensive care unit (NICU).

Methods: A prospective observational study was conducted over 18 months (July 2023-July 2025). Sixty-eight neonates meeting eligibility criteria were enrolled. ROP screening was performed by indirect ophthalmoscopy following NNF guidelines.

Results: ROP incidence was 33.8%, 82.6% had mild ROP (stages 1-3) and 17.4% had severe ROP. Pregnancy-induced hypertension (PIH) was the only significant maternal risk factor (p=0.002). Significant neonatal risk factors included gestational age 28-32 weeks and birth weight 1-1.5 kg (both p<0.001), respiratory distress syndrome (p=0.001), apnea (p=0.002), sepsis (p=0.011), necrotising enterocolitis (p=0.001), culture-positive sepsis (p=0.004), mechanical ventilation (p=0.003), non-invasive ventilation (p=0.006), surfactant therapy (p=0.002), and blood transfusion (p=0.001). Among neonates with ROP, apnea was the sole predictor of severe disease (p=0.024). All four severe ROP cases received laser photocoagulation; in addition, two babies also required anti-VEGF therapy.

Conclusions: ROP incidence was 33.8%, consistent with Indian tertiary-centre reports. Prematurity, low birth weight, PIH, sepsis, RDS, NEC, apnea, ventilatory support, and blood transfusion are key risk factors. Apnea is a significant predictor of severe ROP. Timely screening and management of modifiable risk factors are essential to reduce ROP-associated blindness.