Risk factors and prevalence of retinopathy of prematurity in very low birth weight preterm infants: a systematic review and meta-analysis.

BACKGROUND

Retinopathy of prematurity (ROP) is a potentially blinding disorder affecting preterm infants, especially those with very low birth weight (<1,500 g). While advances in neonatal care have improved survival, the incidence of ROP remains high, and risk factors vary across studies. This meta-analysis aims to determine the prevalence of ROP in very low birth weight preterm infants and identify key risk factors to inform clinical screening and preventive strategies.

METHODS

PubMed, Embase, Cochrane Library, and Web of Science databases were searched from database creation to January 7, 2026. Stata 15.0 was used to merge and analyze the data.

RESULTS

Fourteen articles (including three case-control studies and 11 cohort studies) involving 12,666 newborns were finally included, and the results of meta-analysis found that blood transfusion [odds ratio (OR) =1.81, 95% confidence interval (CI): 1.37-2.39, P=0.001], low gestational age (OR =1.50, 95% CI: 1.21-1.86, P=0.001), low birth weight (OR =1.05, 95% CI: 1.02-1.08, P=0.02), sepsis (OR =1.47, 95% CI: 1.26-1.71, P=0.02), intraventricular hemorrhage (OR =1.87, 95% CI: 1.27-2.75, P=0.001), lung disease (OR =2.08, 95% CI: 1.37-3.17, P=0.001), necrotizing enterocolitis (OR =1.68, 95% CI: 1.16-2.41, P=0.001), and patent ductus arteriosus (OR =1.72, 95% CI: 1.31-2.25, P=0.003) were risk factors for ROP in very low birth weight preterm infants.

CONCLUSIONS

The study suggests ROP should be prevented early in very low birth weight preterm infants with a combination of blood transfusions, low gestational age, low gestational weight, sepsis, intraventricular hemorrhage, lung disease, necrotizing enterocolitis, and patent ductus arteriosus.