Retinopathy of prematurity in late preterm and early term neonates: Incidence and risk factors in a prospective cohort

Abstract

Background

The predominant risk factors and outcomes of ROP in neonates with more than 34 weeks of gestation are not well described in low- and middle-income countries despite higher incidence of ROP in these neonates.

Objectives

To determine the incidence and risk factors of ROP in neonates between 34 weeks and 38 weeks 6 days.

Material and Methods

We conducted a prospective observational study in a tertiary care paediatric hospital from January 2020 to June 2021. Neonates with gestational age between 34 and 38 weeks 6 days were included. Standardized screening protocols were adapted, with data on demographic characteristics, risk factors, ROP findings, and treatment collected systematically.

Results

Among 267 neonates, 224 underwent ROP screening. Fifteen (6.7%) neonates had any ROP, with 6 (2.6%) having Type I ROP requiring treatment. Among the cohort, higher proportions of late preterm neonates had ROP 12 (8.5%) compared to early term neonates 3 (3.6%) and amongst the neonates who required treatment, 6 (2.6%) all were late preterm neonates. Significant risk factors for ROP development included being small for gestational age [12 (80%) versus 58 (28%), p < 0.01], postnatal weight gain [Mean Difference: 9.8 gm/kg/day; 95% CI, 6.7 – 13.0, p < 0.001] and associated comorbidities such as respiratory support [15 (100%) versus 128 (61%), p < 0.01], shock [13 (86.7%) versus 118 (56.5%), p < 0.01] and sepsis [3 (20% vs 22 (10%); p < 0.01].

Conclusions

Our study supports extending ROP screening to neonates ≥34 weeks with growth restriction or comorbidities, particularly in low- and middle-income settings.