A study of the factors associated with retinopathy of prematurity

The present study aimed to identify independent risk factors for retinopathy of prematurity (ROP) in preterm infants and to evaluate the predictive utility of maternal third-trimester apolipoprotein A1 (ApoA1) for early risk stratification. The present retrospective case-control study enrolled preterm infants who underwent ROP screening in the Departments of Neonatology and Ophthalmology in Hebei General Hospital (Shijiazhuang, China) between September 2018 and July 2023. Infants were stratified into a no-ROP group (n=22) or an ROP group (n=80) based on findings from dilated fundus examination. Maternal third-trimester lipid profiles and serial neonatal hematological and biochemical indices (collected within 24 h of birth and at 1 week of age) were extracted from electronic medical records. Binary logistic regression was performed to identify independent risk factors, and receiver operating characteristic (ROC) curves were constructed to evaluate predictive performance. Univariate analysis revealed statistically significant differences between the no-ROP and ROP groups with regard to gestational age, birth weight, 1-min Apgar score, neonatal pneumonia, neonatal bronchopulmonary dysplasia, neonatal respiratory distress syndrome, sepsis, blood transfusion, maternal apolipoprotein A1 (ApoA1), platelet count at 24 h and 1 week, 1-week mean platelet volume, 1-week hemoglobin, 1-week neutrophil-to-lymphocyte ratio and 1-week lymphocyte-to-monocyte ratio (all P<0.05). Multivariate logistic regression analysis identified reduced maternal third-trimester ApoA1 as the sole independent risk factor for ROP (P<0.05). ROC analysis demonstrated that maternal ApoA1 <0.584 g/l predicted increased ROP risk with 90.9% sensitivity and 67.5% specificity (area under the curve, 0.768; 95% confidence interval, 0.661-0.875; P<0.001). In conclusion, teduced maternal third-trimester ApoA1 is an independent predictor of ROP development, demonstrating high sensitivity for early risk identification. These findings support the integration of maternal lipid profiling into ROP screening algorithms and underscore the clinical importance of enhanced surveillance for infants born to mothers with reduced ApoA1 levels.