Afsana Habib Sheuly^1,, Dipak Kumar Nag², Faiza Rahlaa³, Biplob Banerjee⁴, Mohammad Delwer Hossain Hawlader⁵

Background: Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the immature retina that has emerged as a leading cause of preventable childhood blindness worldwide. In low- and middle- income countries, improvements in neonatal survival have been accompanied by an increasing incidence of ROP, often affecting relatively more mature and heavier preterm infants than in high- income settings. Despite this growing burden, there is limited data on the maternal and neonatal risk profiles for ROP in Bangladesh, which hampers the development of targeted screening strategies. This study aimed to identify key perinatal factors associated with ROP in a tertiary care setting to guide evidence-based screening and prevention protocols. Methods: A hospital-based case–control study was conducted in the Special Neonatal Care Unit (SNCU) of Dhaka Shishu Hospital over a six-month period from February to July 2019. Eligible infants were those born before 34 weeks’ gestation with a birth weight below 1750 g who were enrolled in the hospital’s ROP screening program. Cases (n = 143) were infants diagnosed with ROP; controls (n = 143) met the same inclusion criteria but had no ROP. Data on maternal obstetric history, antenatal complications, and neonatal clinical course were extracted from hospital records. Bivariate analyses were performed to assess associations between potential risk factors and ROP occurrence. Results: The mean gestational age of ROP cases was slightly lower than controls (29.93 ± 2.27 vs. 30.43 ± 2.54 weeks), and mean birth weight was also lower (1283.03 ± 299.33 g vs. 1348.93 ± 419.76 g), though neither difference reached statistical significance. Significant neonatal risk factors included apnea (35.0% vs. 19.6%, p = 0.003), respiratory distress syndrome (54.5% vs. 27.3%, p = 0.001), and blood transfusion (77.6% vs. 55.2%, p < 0.0001). Among maternal factors, high parity (≥4 previous deliveries) was significantly associated with ROP (18.9% vs. 9.8%, p = 0.021), and prolonged rupture of membranes showed a borderline association (37.1% vs. 27.3%, p = 0.050). Oxygen therapy, though historically a strong risk factor, was not significant in this study, likely due to its near-universal use and improved oxygen monitoring practices. Conclusion: The findings indicate that ROP in this context is strongly linked to neonatal respiratory instability and transfusion history, as well as selected maternal obstetric factors. Integrating these risk markers into screening protocols could improve early detection and allow timely intervention, thereby preventing irreversible visual impairment in preterm infants. Significance: A dual-focus approach addressing modifiable neonatal care practices and strengthening maternal risk-based surveillance should be prioritized in tertiary neonatal care units across Bangladesh to curb the burden of ROP-related blindness.

Retinopathy of Prematurity, Premature Infants, Low Birth Weight, Neonatal Risk Factors, Maternal Risk Factors, Preventable Blindness, Case–Control Study, Neonatal Screening, Ophthalmic Public Health