Risk Factors for Retinopathy of Prematurity in a Tertiary Care Hospital, Bangladesh

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

¹Head of Health and Nutrition, Helen Keller International, Dhaka, Bangladesh

²Ex Head of the department: Vitreo Retina, National Institute of Ophthalmology and Hospital

³Research Associate, Department of Public Health, North South University, Dhaka, Bangladesh

⁴Director- Strategy & Growth, Harvesting Knowledge Empowering Change, Transforming Future, Dhaka, Bangladesh

⁵Director, Department of Public Health, NSU Global Health Institute (NGHI), North South University, Dhaka, Bangladesh

Cite this paper:
Afsana Habib Sheuly, Dipak Kumar Nag, Faiza Rahlaa, Biplob Banerjee and Mohammad Delwer Hossain Hawlader. Risk Factors for Retinopathy of Prematurity in a Tertiary Care Hospital, Bangladesh. American Journal of Public Health Research. 2025; 13(5):238-244. doi: 10.12691/ajphr-13-5-5

Abstract

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.

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

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Fleck BW, Dangata Y. Causes of visual handicap in the Royal Blind School, Edinburgh, 1991–2. Br J Ophthalmol. 1994; 78(5): 421.
[2]	Wagner RS. Increased incidence and severity of retinopathy of prematurity in developing nations. J Pediatr Ophthalmol Strabismus. 2003; 40(4): 193–98.
[3]	Early Treatment for Retinopathy of Prematurity Cooperative Group. Revised indications for the treatment of retinopathy of prematurity: Results of the Early Treatment for ROP randomized trial. Arch Ophthalmol. 2003; 121(12): 1684–94.
[4]	Slidsborg C, Jensen A, Forman JL, et al. Neonatal risk factors for treatment-demanding retinopathy of prematurity: a Danish national study. Ophthalmology. 2016; 123(4): 796–803.
[5]	Gupta VP, Dhaliwal U, Sharma R, et al. Retinopathy of prematurity – risk factors. Indian J Pediatr. 2004; 71(10): 887–92.
[6]	Kim TI, Sohn J, Pi SY, Yoon YH. Postnatal risk factors of retinopathy of prematurity. Paediatr Perinat Epidemiol. 2004; 18(2): 130–4.
[7]	Varughese S, Jain S, Gupta N, et al. Magnitude of the problem of ROP: Experience in a large maternity unit with a level-3 nursery. Indian J Ophthalmol. 2001; 49(3):187–8.
[8]	Nag D, Habib SA, Paul R, et al. Evaluation of screening for ROP: Recent advancements in our understanding in Bangladesh. J Ophthalmol Soc Bangladesh. 2018; 45(1): 113–22.
[9]	Fierson WM, et al. Screening examination of premature infants for retinopathy of prematurity: Policy statement. Pediatrics. 2013; 131(1): 189–95.
[10]	Gilbert C, Fielder A, Gordillo L, et al. Characteristics of infants with severe ROP in countries with low, moderate, and high levels of development: implications for screening programs. Pediatrics. 2005; 115(5): e518–25.
[11]	Jalali S, Matalia J, Hussain A, Anand R. Modification of screening criteria for ROP in India and other middle-income countries. Am J Ophthalmol. 2006; 141(5): 966–8.
[12]	Vinekar A, Dogra MR, Sangtam T, et al. Retinopathy of prematurity in Asian Indian babies >1250 g birth weight: Ten-year data from a tertiary center in a developing country. Indian J Ophthalmol. 2007; 55(5): 331–6.
[13]	Phan MH, Nguyen PN, Reynolds JD. Incidence and severity of ROP in Vietnam, a developing middle-income country. J Pediatr Ophthalmol Strabismus. 2003; 40(4): 208–12.
[14]	14.Shrestha JB, Bajimaya S, Sharma AK, et al. Incidence of ROP in a neonatal intensive care unit in Nepal. J Pediatr Ophthalmol Strabismus. 2010; 47(5): 297–300.
[15]	Adhikari S, Badhu BP, Bhatta NK, et al. Retinopathy of prematurity in a tertiary care hospital in eastern Nepal. JNMA J Nepal Med Assoc. 2008; 47(169): 24–7.
[16]	Shah VA, Yeo CL, Ling YL, Ho LY. Incidence and risk factors of ROP among VLBW infants in Singapore. Ann Acad Med Singap. 2005; 34(2): 169–73.
[17]	Trinavarat A, Atchaneeyasakul L, Udompunturak S. Application of American and British criteria for ROP screening in Thailand. Jpn J Ophthalmol. 2004; 48(1): 50–3.
[18]	Liu PM, Fang PC, Huang CB, et al. Risk factors of ROP in infants <1600 g. Am J Perinatol. 2005; 22(2): 115–20.
[19]	Quinn GE, Gilbert C, Darlow BA, Zin A. Retinopathy of prematurity: An epidemic in the making. Chin Med J (Engl). 2010; 123(20): 2929–37.
[20]	Cryotherapy for ROP Cooperative Group. Multicenter trial of cryotherapy for ROP: Three-month outcome. Arch Ophthalmol. 1990; 108(2): 195–204.
[21]	Mittelman D, Cronin C. The relationship of blood transfusions to retrolental fibroplasia. Ann Ophthalmol. 1983; 15(11): 376–8.
[22]	Purohit DM, Ellison RC, Zierler S, et al. Risk factors for retrolental fibroplasia: Experience with 3,025 premature infants. Pediatrics. 1985; 76(3): 339–44.
[23]	Hirano K, Morinobu T, Kim H, et al. Blood transfusion increases free iron and enhances oxidative stress in premature infants. Arch Dis Child Fetal Neonatal Ed. 2001; 84(3): F188–93.
[24]	Valieva OA, Strandjord TP, Mayock DE, et al. Effects of blood transfusions on ROP in extremely low birth weight infants. J Perinatol. 2006; 26(6): 337–41.
[25]	Boskabadi H, Shoeibi N, Bagheri F, et al. Potential role of bilirubin in preventing ROP. Curr Pediatr Rev. 2023; 19(2): 197–202.
[26]	Rallabandi S, Amin SB, et al. Bilirubinemia and retinopathy of prematurity in infants ≤29 weeks’ gestational age. Pediatr Res. 2024.