Risk Factors for Retinopathy of Prematurity in Very-Low-Birth-Weight Preterm Infants, With Special Reference to Postnatal Weight Gain.

OBJECTIVE: This study aimed to evaluate the relationship between postnatal weight gain and the risk of developing severe retinopathy of prematurity (ROP) in preterm neonates with very-low-birth-weight (VLBW) and extremely low birth weight (ELBW). METHODOLOGY: This prospective observational study was conducted in the Special Neonatal Care Unit (SNCU) of Sriramachandra Bhanja Medical College and Hospital (SCBMCH) and Sardar Vallabh Bhai Patel Postgraduate Institute of Paediatrics (SVPPGIP), Cuttack, from January 2023 to July 2024. Preterm neonates with birth weight < 1,500 g and gestational age < 34 weeks were enrolled, excluding those with significant congenital or ocular anomalies or requiring ventilator support. Detailed clinical history, risk factors, and serial weight measurements were recorded until six weeks postnatal age. Data were analyzed using SPSS (IBM Corp., Armonk, NY, USA), employing univariate analyses, chi-squared tests, Mann-Whitney tests, and logistic regression to identify risk factors for ROP. RESULTS: Of 200 neonates, severe ROP was observed in 124 (38%). Logistic regression identified lower gestational age (odds ratio (OR) = 81.639), lower birth weight (OR = 11.371), apnea (OR = 34.594), and poor weight gain during the second and third weeks as significant risk factors for severe ROP. Mean weight gain increased from 8.3 ± 3.4 g/kg/day in the second week to 16.2 ± 5.4 g/kg/day by the sixth week. Poor weight gain in the second (OR = 0.699) and third (OR = 0.556) weeks was associated with a higher risk of severe ROP. CONCLUSION: While low gestational age and birth weight remain primary risk factors, additional factors, including prolonged oxygen therapy, bronchopulmonary dysplasia, anemia, and repeated blood transfusions, also contribute to ROP severity. Infants with poor weight gain in the second and third weeks post-birth had a significantly higher risk of developing severe ROP (p < 0.0001), highlighting the importance of early nutritional monitoring in high-risk preterm neonates.