The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Incidence of Retinopathy in Preterm Neonates Hospitalized in Imam Reza Hospital of Mashhad in 2020-2021

Document Type : Original Article

Authors
Gulalai Zamary Khan 1
Ezzat Khodashenas 2
Ahmad Shah Farhat 2
Ashraf Mohamadzade 3
Elham Bakhtiari 4
Alireza Sohrabi 5
1 Pediatrician, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Associate Professor, Department of Neonatology, Neonatal Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Professor, Department of Neonatology, Neonatal Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
4 Assistant Professor, Department of Pharmacology, Clinical Research Development Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
5 Orthopedic Surgery Resident, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
10.22038/ijogi.2026.89762.6501
Abstract
Introduction: Retinopathy of prematurity (ROP) is one of the leading causes of visual impairment and blindness in premature infants. The present study was conducted with aim to determine the frequency and the risk factors related to ROP in premature newborns hospitalized in the neonatal intensive care unit.
Methods: In this retrospective cohort study, the infants <2000 gr who met the inclusion criteria were selected among newborns born from 2020 to 2021 and underwent ROP evaluation. Patients were followed up regarding the development of ROP and, in case of development, its location. In cases where ROP occurred, the affected zone was recorded as follows: Zone I (the most central and severe involvement); Zone II (the intermediate zone with more common and moderate involvement); and Zone III (the most peripheral and mildest involvement). The relationship of gestational age, sex, and birth weight with the ROP and its severity was evaluated. Data were analyzed using SPSS (version 26) and Independent t-test, Mann–Whitney test, Chi-square test, and analysis of variance (ANOVA). P<0.05 was considered significant.
Results: A total of 374 newborns were included, of which 258 (68.98%) had ROP. Gestational age (p<0.001) and weight (p<0.001) of newoborns with ROP were significantly lower than other newborns. Also, their duration of hospitalization was significantly longer (p<0.001). Most ROP occurred in zone II (61.5%). Gestational age (p<0.001) and birth weight (p<0.001) of patients with ROP in different zones were significantly different (p<0.001).
Conclusion: The frequency of ROP in the studied newborns was higher than that reported in some previous studies. Lower birth weight and gestational age, and longer hospitalization are the most important factors related to developing ROP in premature newborns.
Keywords
Birth Weight
Premature Newborn
Retinopathy of Prematurity
Subjects
1.        Braimah IZ, Enweronu-Laryea C, Sackey AH, Kenu E, Agyabeng K, Ofori-Adjei IO, et al. Incidence and risk factors of retinopathy of prematurity in Korle-Bu Teaching Hospital: a baseline prospective study. BMJ open 2020; 10(8):e035341.
2.        de las Rivas Ramírez N, Luque Aranda G, Rius Diaz F, Perez Frias FJ, Sánchez Tamayo T. Risk factors associated with retinopathy of prematurity development and progression. Scientific reports 2022; 12(1):21977.
3.        Zhang M, Xu G, Wang X, Ni Y, Huang X. Rate and treatment of retinopathy of prematurity in extremely low birth weight infants with gestational age≤ 28 weeks in eastern China. Risk Management and Healthcare Policy 2020:2867-73.
4.        Raghuveer TS, Zackula R. Strategies to prevent severe retinopathy of prematurity: a 2020 update and meta-analysis. Neoreviews 2020; 21(4):e249-63.
5.        Ahn JH, Lee KM, Kim MJ, Park HK, Kim YJ, Ahn SJ, et al. Neurodevelopmental outcomes in very low birthweight infants with retinopathy of prematurity in a nationwide cohort study. Scientific Reports 2022; 12(1):5053.
6.        Dericioğlu V, Butur S, Celiker H, Şahin Ö. Incidence, risk factors and screening evaluation of retinopathy of prematurity in high birthweight infants: a large cohort study in Turkey. Ophthalmic Epidemiology 2022; 29(1):78-84.
7.        AlBalawi HB, AlBalawi NS, AlSuhaimi NA, AlBalawi AA, AlAtawi AS, Mirghani HO, et al. Incidence and risk factors for retinopathy of prematurity in Tabuk City, KSA. Middle East African Journal of Ophthalmology 2020; 27(2):105-9.
8.        Carranza-Mendizabal CS, Diaz-Manrique M, Ruiz Mamani PG, White M, Huancahuire-Vega S. Incidence and risk factors associated with retinopathy of prematurity in Peru. Clinical Ophthalmology 2021:2141-8.
9.        Yildiz Ekinci D, Ugurlu A, Tasli NG. What is the incidence of retinopathy of prematurity (ROP) in ‘big’babies?: results of a retrospective multicenter study. Ophthalmic epidemiology 2021; 28(2):138-43.
10.     Yildirim M, Coban A, Bulut O, Mercül NK, Ince Z. Postnatal weight gain and retinopathy of prematurity in preterm infants: a population-based retrospective cohort study. The Journal of Maternal-Fetal & Neonatal Medicine 2024; 37(1):2337720.
11.     Prakalapakorn SG, Greenberg L, Edwards EM, Ehret DE. Trends in retinopathy of prematurity screening and treatment: 2008–2018. Pediatrics 2021; 147(6):e2020039966.
12.     Ryu J. New aspects on the treatment of retinopathy of prematurity: currently available therapies and emerging novel therapeutics. International journal of Molecular sciences 2022; 23(15):8529.
13.     Ng TR, Wong IB, Ngo CS, Niduvaje K, Ngiam XY, Sensaki S, et al. Case control study of risk factors and ophthalmological outcomes of very low birth weight infants with Type 1 retinopathy of prematurity. Singapore medical journal 2020; 61(8):426.
14.     Ali SK, Mohammed N, Qureshi N, Gupta S. Oxygen therapy in preterm infants: recommendations for practice. Paediatrics and Child Health 2021; 31(1):1-6.
15.     Kapadia V, Oei JL. Optimizing oxygen therapy for preterm infants at birth: Are we there yet?. InSeminars in Fetal and Neonatal Medicine 2020; 25(2):101081.
16.     Schulzke SM, Stoecklin B. Update on ventilatory management of extremely preterm infants—A Neonatal Intensive Care Unit perspective. Pediatric Anesthesia 2022; 32(2):363-71.
17.     Sahiledengle B, Tekalegn Y, Zenbaba D, Woldeyohannes D, Teferu Z. Which factors predict hospital length-of-stay for children admitted to the neonatal intensive care unit and pediatric ward? A hospital-based prospective study. Global pediatric health 2020; 7:2333794X20968715.
18.     Kapur N, Nixon G, Robinson P, Massie J, Prentice B, Wilson A, et al. Respiratory management of infants with chronic neonatal lung disease beyond the NICU: A position statement from the Thoracic Society of Australia and New Zealand. Respirology 2020; 25(8):880-8.
19.     Egbuta C, Easley RB. Update on ventilation management in the Pediatric Intensive Care Unit. Pediatric Anesthesia 2022; 32(2):354-62.
20.     Regin Y, Gie A, Eerdekens A, Toelen J, Debeer A. Ventilation and respiratory outcome in extremely preterm infants: trends in the new millennium. European Journal of Pediatrics 2022; 181(5):1899-907.
21.     Çömez A, Çelemler P, Özmen MC, Yurttutan S, Akkececi NS, Güngör K, et al. Retinopathy of prematurity incidence and treatment modalities in moderate and late preterm infants: a study from two tertiary centers. Canadian Journal of Ophthalmology 2022; 57(3):195-200.
22.     Mirza BH, Abbasi KZ, Khan MR, Ur M, Rehman MZ, Niazi FA. Incidence of retinopathy of prematurity in infants with low gestational age and low birth weight. Al-Shifa J Ophthalmol 2023; 19(2):77-84.
23.     Borțea CI, Enatescu I, Dima M, Pantea M, Iacob ER, Dumitru C, et al. A prospective analysis of the retinopathy of prematurity correlated with the inflammatory status of the extremely premature and very premature neonates. Diagnostics 2023; 13(12):2105.
24.     Abbasi N, Ramezani M, Shoeibi N, Vashani HB. A study of the prevalence and severity of retinopathy of prematurity in East of Iran during 2015–2017: A descriptive cross-sectional study. Journal of Neonatal Nursing 2022; 28(4):244-8.
25.     Ozgur Gursoy O, Gurer HG, Yildiz Eren C, Erdogan Ozgur P, Gursoy H. The association of various obstetric and perinatal factors with retinopathy of prematurity. International ophthalmology 2022; 42(9):2719-28.
26.     Kim SJ, Port AD, Swan R, Campbell JP, Chan RP, Chiang MF. Retinopathy of prematurity: a review of risk factors and their clinical significance. Survey of ophthalmology 2018; 63(5):618-37.
27.     Shulman JP, Weng C, Wilkes J, Greene T, Hartnett ME. Association of maternal preeclampsia with infant risk of premature birth and retinopathy of prematurity. JAMA ophthalmology 2017; 135(9):947-53.
28.     Carroll L, Owen LA. Current evidence and outcomes for retinopathy of prematurity prevention: insight into novel maternal and placental contributions. Exploration of medicine 2020; 1:4.
29.     Goldstein GP, Leonard SA, Kan P, Koo EB, Lee HC, Carmichael SL. Prenatal and postnatal inflammation-related risk factors for retinopathy of prematurity. Journal of Perinatology 2019; 39(7):964-73.
30.     Martínez-Cruz CF, Salgado-Valladares M, Poblano A, Trinidad-Pérez MC. Risk factors associated with retinopathy of prematurity and visual alterations in infants with extremely low birth weight. Rev Invest Clin 2012; 64(2):136-43.
31.     Badeeb N, Raffa L, AhmedHussain H, Bamefleh D, Mgharbil E, Alessa S, et al. Retinopathy of prematurity in Saudi Arabia: Exploring maternal risk factors. Taiwan Journal of Ophthalmology 2021; 11(4):359-66.
32.     Thomas K, Shah PS, Canning R, Harrison A, Lee SK, Dow KE. Retinopathy of prematurity: risk factors and variability in Canadian neonatal intensive care units. Journal of neonatal-perinatal medicine 2015; 8(3):207-14.
33.     Strawbridge JC, Chu A, Dammann O, Hanson J, Janzen C, Tsui I. Prenatal maternal characteristics associated with retinopathy of prematurity. Retina 2023; 43(2):230-7.
34.     Alshaikh B, Salman O, Soliman N, Ells A, Yusuf K. Pre-eclampsia and the risk of retinopathy of prematurity in preterm infants with birth weight< 1500 g and/or< 31 weeks’ gestation. BMJ open ophthalmology 2017; 1(1).
35.     Smith L. E. (2003). Pathogenesis of retinopathy of prematurity. Seminars in neonatology : SN, 8(6), 469–473. https://doi.org/10.1016/S1084-2756(03)00119-2
36.     Rivera-Rueda MA, Fernández-Carrocera LA, Salgado-Valladares MB, Cordero-González G, Coronado-Zarco IA, Cardona-Pérez JA. Retinopathy of prematurity, frequency and risk factors in very low birth weight infants. Boletin Medico del Hospital Infantil de Mexico 2020; 77(3):135-41.
37.     Çömez A, Çelemler P, Karaküçük Y, Yurttutan S, Soysal GG, Akkeçeci NS. Prevalence, Severity and Treatment Modalities of Retinopathy of Prematurity in Infants Born Before 32 Weeks of Gestation in the Southeastern Region of Türkiye: A 6-Year Retrospective Study. Forbes Journal of Medicine 2025; 6(1):9-16.
38.     Saeidi R, Hashemzadeh A, Ahmadi S, Rahmani S. Prevalence and predisposing factors of retinopathy of prematurity in very low-birth-weight infants discharged from NICU; 2009.
39.     Mansouri MR, Kadivar M, Karkhaneh R, Riazi Esfahani M, Nili Ahmadabadi M, Faghihi H, et al. Prevalence and risk factors of retinopathy of prematurity in very low birth weight or low gestational age infants. Bina J Ophthalmol 2007; 12(4):428-34.
The Iranian Journal of Obstetrics, Gynecology and Infertility
Volume 29, Issue 2
April 2026
Pages 22-30