Early Nutritional Patterns and Metabolic Biomarkers Associated with ROP Severity

Background and Objectives: Retinopathy of prematurity (ROP) remains a leading cause of preventable childhood blindness, with its severity influenced by a complex interaction between nutritional status, metabolic maturation, and systemic vulnerability. This study aimed to evaluate whether early nutritional patterns and serum metabolic parameters, including hepatic and renal biomarkers, are associated with ROP severity and whether they may serve as potential predictors of disease progression. Materials and Methods: We conducted a retrospective study on 140 preterm infants, totaling 280 eyes, admitted between 2021 and 2024 in two neonatal intensive care units (NICU). Each eye was analyzed independently according to International Classification of Retinopathy of Prematurity (ICROP) criteria. Data on the timing of enteral feeding, duration and type of nutrition, and serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), total protein, blood glucose, urea and creatinine were collected throughout the first 28 days of life. Statistical analysis included Kruskal-Wallis and Chi-square tests, with a significance threshold of p < 0.05. Results: ROP was identified in 53.57% of cases. Enteral feeding began earlier in infants without ROP, whereas delayed initiation and prolonged parenteral nutrition were associated with more advanced stages. Natural feeding decreased with increasing severity and was absent in aggressive retinopathy of prematurity (A-ROP). Severe disease stages showed higher AST, ALT, urea and creatinine levels, along with lower early total protein values. Glycemic instability was observed more frequently in stage 2 and stage 3. Conclusions: Early nutritional support, especially early enteral feeding and natural feeding, appears protective against ROP progression. Hepatic, renal and glycemic metabolic changes are closely correlated with disease severity, indicating that metabolic balance reflects overall vulnerability in preterm infants. Incorporating nutritional and metabolic assessment into routine screening may enhance early risk identification and optimize clinical monitoring.