Risk factors for severe retinopathy of prematurity: A retrospective case-control study

The present study aimed to investigate the risk factors associated with severe retinopathy of prematurity (ROP) in preterm infants and to identify predictive biomarkers for early risk stratification. The present retrospective case-control study analyzed preterm infants who underwent ROP screening at Hebei General Hospital (Shijiazhuang, China) between September 2018 and July 2023. Participants were stratified into mild (n=42) and severe ROP (n=38) groups based on fundus examination results and treatment requirements. Demographic characteristics, perinatal complications, maternal third-trimester lipid profiles and serial hematological parameters (within 24 h of birth and at 1 week of age) were analyzed. Binary logistic regression analysis was performed to identify independent risk factors, and receiver operating characteristic (ROC) curves were constructed to evaluate predictive performance. Significant differences were observed between severe and mild ROP groups in gestational age, birth weight and 1-min Apgar score (all P<0.001). Perinatal complications significantly associated with severe ROP included neonatal bronchopulmonary dysplasia (P<0.001), neonatal respiratory distress syndrome (P=0.003), neonatal sepsis (P=0.009) and blood transfusion requirements (P<0.001). Among hematological parameters, lymphocyte-to-monocyte ratio (LMR) was significantly lower in the severe ROP group both within 24 h of birth (P=0.015) and at 1 week of age (P=0.01). Multivariate logistic regression identified gestational age as the sole independent risk factor for severe ROP (P<0.001). ROC curve analysis revealed that gestational age ≤30.5 weeks predicted severe ROP with 76.2% sensitivity and 71.1% specificity (P<0.001). Maternal third-trimester lipid parameters showed no significant associations with severe ROP development. In conclusion, gestational age represents the most significant independent predictor of severe ROP in preterm infants, with infants born at ≤30.5 weeks showing significantly increased risk. Additional risk factors include major perinatal complications and altered inflammatory profiles characterized by reduced LMR. These findings support enhanced surveillance protocols for preterm infants and suggest the potential utility of inflammatory biomarkers in ROP risk stratification strategies.