Retinopathy of prematurity (ROP) is a vasoproliferative disorder of the incompletely vascularized retina that occurs predominantly in preterm infants. Although early stages may regress spontaneously, progressive disease can lead to retinal traction, detachment and permanent visual impairment. ROP remains an important potentially avoidable cause of childhood blindness, and its epidemiological pattern varies substantially with the level of neonatal care, survival of very preterm infants, and availability of organized screening and treatment programmes.[1,2] The burden of ROP has changed considerably over time. In many low- and middle-income countries, including India, improved survival of premature and low-birth-weight infants has been accompanied by an increasing population at risk for ROP. This has been described as the “third epidemic” of ROP, characterized not only by increasing survival of highly immature infants but also by considerable variation in neonatal care and screening coverage.[3] Importantly, infants developing severe ROP in middle-income settings may have a wider range of birth weights and gestational ages than those typically affected in high-income countries, making locally appropriate screening strategies essential.[1,2] Prematurity and low birth weight are the most consistently recognized determinants of ROP. However, the development and progression of the disease are multifactorial. Oxygen exposure, respiratory morbidity, mechanical ventilation, sepsis, apnea, intraventricular haemorrhage, anemia, and blood transfusion have all been investigated as associated neonatal factors. In the Indian setting, the relationship between these variables and ROP is especially relevant because differences in case mix, survival patterns and neonatal intensive-care practices can influence both disease frequency and severity.[4,6,7] The clinical description of ROP has also evolved. The International Classification of Retinopathy of Prematurity, Third Edition (ICROP3), provides contemporary terminology for describing retinal zone, stage, vascular abnormalities, aggressive ROP, and patterns of regression and reactivation. Standardized classification is important for meaningful comparison of disease severity and outcomes across institutions and populations.[5] Indian studies have reported considerable variation in the occurrence of ROP. Rao et al. observed any ROP in 21.6% and severe ROP in 6.7% of 282 at-risk preterm infants in a South Indian tertiary centre; lower birth weight and gestational age were important determinants, while intraventricular haemorrhage emerged as an independent predictor of severe disease.[6] Goyal et al., in a large NICU-based screening programme involving 824 infants, reported ROP in 25.36% of screened infants and identified lower haemoglobin, greater oxygen requirement and a higher number of blood transfusions as factors associated with more severe type 1 disease.[7] Marked regional variation has also been demonstrated. Le et al. reported ROP in 2.3% of NICU admissions in a tertiary centre in Telangana, with oxygen exposure and respiratory distress syndrome being common among affected infants.[8] More recently, Kumaresan et al. reported ROP in 5.1% of 375 screened neonates at a tertiary centre in Chennai, with earlier gestational age and lower birth weight showing strong associations with delayed retinal vascular development.[9] Such differences probably reflect variation in eligibility criteria, neonatal survival, referral patterns, clinical characteristics and screening practices rather than a uniform underlying disease frequency. Regional data from contemporary neonatal units therefore remain important, particularly among very preterm infants who carry the greatest biological vulnerability to ROP. The present study was undertaken to determine the prevalence and clinical pattern of ROP among neonates born at less than 32 weeks of gestation and to evaluate the major factors associated with its development, severity, treatment requirement and documented outcome in a tertiary-care neonatal intensive care unit in Kurnool, Andhra Pradesh. Aim To determine the prevalence, risk predictors, and treatment outcomes of retinopathy of prematurity among preterm neonates born at less than 32 weeks of gestation. Objectives 1. To determine the prevalence and clinical pattern of retinopathy of prematurity among neonates born at less than 32 weeks of gestation. 2. To identify the major risk predictors associated with the development, severity, treatment requirement, and outcome of retinopathy of prematurity.

This was a retrospective, hospital-based observational study conducted to evaluate the prevalence, associated risk predictors, clinical profile, treatment requirement, and documented outcomes of retinopathy of prematurity (ROP) among preterm neonates born at less than 32 weeks of gestation. Study Setting and Location The study was conducted in the Neonatal Intensive Care Unit (NICU), Department of Paediatrics, Kurnool Medical College, Kurnool, Andhra Pradesh, India. Clinical information was obtained from the neonatal records and available ROP screening and follow-up records maintained during routine care. Study Period The study included eligible neonates managed during the 12-month period from April 2025 to March 2026. Study Population All preterm neonates born at a gestational age of less than 32 completed weeks and managed in the NICU during the study period were considered for inclusion, subject to availability of adequate neonatal and ROP screening records. Inclusion Criteria Neonates were included when they fulfilled the following criteria: 1. Gestational age at birth of <32 completed weeks. 2. Admission or management in the NICU during the defined study period. 3. Availability of documented ROP screening findings. 4. Availability of relevant neonatal clinical information required for assessment of potential risk factors. Exclusion Criteria Neonates were excluded if: 1. ROP screening could not be completed or the screening record was unavailable. 2. Essential neonatal clinical data were substantially incomplete. 3. A congenital ocular or retinal abnormality likely to interfere with assessment of ROP was documented. 4. Follow-up information required for assessment of treatment outcome was unavailable in infants who underwent ROP treatment. Data Collection Data were collected retrospectively from NICU case records, discharge summaries, investigation reports, treatment charts, and available ophthalmology/ROP screening records using a structured data collection format.The neonatal variables recorded included gestational age, birth weight, sex, mode of delivery, multiple gestation, antenatal corticosteroid exposure, respiratory distress syndrome, surfactant administration, apnea of prematurity, sepsis, patent ductus arteriosus, intraventricular haemorrhage, necrotizing enterocolitis, anemia, blood transfusion, supplemental oxygen exposure, respiratory support, CPAP, and mechanical ventilation, wherever reliably documented.For oxygen and respiratory support, the duration of therapy and other quantitative parameters were recorded when consistently available in the clinical records. Missing values were not retrospectively inferred. ROP Assessment ROP screening findings documented during routine clinical care were reviewed. The ophthalmological information collected included: • presence or absence of ROP, • laterality, • retinal zone, • stage of ROP, • presence of plus or pre-plus disease, • aggressive ROP where documented, • maximum severity attained during follow-up, and • requirement for treatment. The retinal findings were described using the terminology of the International Classification of Retinopathy of Prematurity, Third Edition (ICROP3) wherever the available clinical documentation permitted contemporary classification. Outcome Measures The primary outcome was the occurrence of any ROP among eligible neonates born at less than 32 weeks of gestation. Secondary outcomes included: • severity and clinical pattern of ROP, • treatment-requiring ROP, • factors associated with development of ROP, • independent predictors of ROP, where the number of events permitted multivariable analysis, and • documented treatment outcome. Statistical Analysis Data were entered into a structured database and checked for completeness before analysis. Continuous variables were summarized as mean ± standard deviation for approximately normally distributed data and as median with interquartile range for skewed data. Categorical variables were expressed as frequency and percentage. The prevalence of ROP was calculated as the proportion of eligible infants who developed ROP during the study period. Clinical and demographic characteristics were compared between infants who developed ROP and those who did not. The Chi-square test or Fisher's exact test was used for categorical variables, as appropriate. For continuous variables, the independent-samples t-test or Mann–Whitney U test was used depending on the distribution of the data. Potential predictors of ROP were initially evaluated using univariable analysis. Clinically relevant variables with adequate data and appropriate statistical association were considered for multivariable binary logistic regression, subject to the number of ROP events and avoidance of excessive model fitting. Results of regression analysis were expressed as odds ratios with 95% confidence intervals. A P value <0.05 was considered statistically significant. Ethical Considerations The study was conducted after approval from the appropriate Institutional Ethics Committee of Kurnool Medical College, Kurnool. As this was a retrospective record-based study, no additional intervention was performed for research purposes. Patient confidentiality was maintained by using coded study identifiers and excluding personally identifiable information from the analytical dataset and manuscript.

During the study period from June 2025 to May 2026, a total of 1,250 deliveries were recorded at the study centre. Among these, 300 neonates born at less than 32 completed weeks of gestation fulfilled the predefined eligibility criteria and constituted the final study population, representing 24.0% of the total deliveries recorded during the study period. The mean gestational age of the study population was 29.8 ± 1.6 weeks, and the mean birth weight was 1284 ± 318 g. Of the 300 neonates, 45 (15.0%) were born before 28 weeks of gestation, 95 (31.7%) between 28 and 29+6 weeks, and 160 (53.3%) between 30 and 31+6 weeks. Fifty-five neonates (18.3%) had a birth weight below 1000 g, 165 (55.0%) weighed 1000–1499 g, and 80 (26.7%) weighed ≥1500 g. Table 1. Baseline demographic and perinatal characteristics of the study population Characteristic Total (n=300) Gestational age, weeks, mean ± SD 29.8 ± 1.6 <28 weeks 45 (15.0%) 28–29+6 weeks 95 (31.7%) 30–31+6 weeks 160 (53.3%) Birth weight, g, mean ± SD 1284 ± 318 <1000 g 55 (18.3%) 1000–1499 g 165 (55.0%) ≥1500 g 80 (26.7%) Male 170 (56.7%) Female 130 (43.3%) Multiple gestation 49 (16.3%) Caesarean delivery 184 (61.3%) Antenatal corticosteroid exposure 207 (69.0%) Prevalence and clinical profile of ROP Retinopathy of prematurity was diagnosed in 72 of the 300 neonates, giving an overall prevalence of 24.0%. The remaining 228 neonates (76.0%) did not develop ROP. Among the 72 infants with ROP, Stage 1 disease was observed in 34 (47.2%), Stage 2 in 25 (34.7%), Stage 3 in 12 (16.7%), and Stage 4 in one infant (1.4%). No Stage 5 disease was observed. Zone II was the most frequent location, occurring in 42 infants (58.3%), followed by Zone III in 21 (29.2%) and Zone I in 9 (12.5%). Plus disease was documented in 18 infants (25.0%), aggressive ROP in 6 (8.3%), and bilateral involvement in 54 (75.0%). Table 2. Clinical characteristics of ROP among affected neonates Characteristic n (%) (n=72) Stage 1 34 (47.2%) Stage 2 25 (34.7%) Stage 3 12 (16.7%) Stage 4 1 (1.4%) Stage 5 0 Zone I 9 (12.5%) Zone II 42 (58.3%) Zone III 21 (29.2%) Plus disease 18 (25.0%) Aggressive ROP 6 (8.3%) Bilateral ROP 54 (75.0%) Unilateral ROP 18 (25.0%) Association of gestational age with ROP The prevalence of ROP increased significantly with decreasing gestational age. Among neonates born before 28 weeks of gestation, 24 of 45 (53.3%) developed ROP. The corresponding proportions were 28 of 95 (29.5%) among infants born between 28 and 29+6 weeks and 20 of 160 (12.5%) among those born between 30 and 31+6 weeks. The association between gestational-age category and ROP was statistically significant (χ²=34.39, P<0.001). Table 3. Distribution of ROP according to gestational age Gestational age Total ROP, n (%) No ROP, n (%) <28 weeks 45 24 (53.3%) 21 (46.7%) 28–29+6 weeks 95 28 (29.5%) 67 (70.5%) 30–31+6 weeks 160 20 (12.5%) 140 (87.5%) Total 300 72 (24.0%) 228 (76.0%) χ²=34.39; P<0.001 Association of birth weight with ROP ROP prevalence also increased significantly with decreasing birth weight. ROP was diagnosed in 28 of 55 infants (50.9%) weighing <1000 g, 37 of 165 (22.4%) weighing 1000–1499 g, and 7 of 80 (8.8%) weighing ≥1500 g. This association was statistically significant (χ²=32.26, P<0.001). Table 4. Distribution of ROP according to birth-weight category Birth weight Total ROP, n (%) No ROP, n (%) <1000 g 55 28 (50.9%) 27 (49.1%) 1000–1499 g 165 37 (22.4%) 128 (77.6%) ≥1500 g 80 7 (8.8%) 73 (91.2%) Total 300 72 (24.0%) 228 (76.0%) χ²=32.26; P<0.001 Neonatal factors associated with ROP Respiratory distress syndrome, surfactant administration, supplemental oxygen exposure, mechanical ventilation, apnea of prematurity, culture-positive sepsis, patent ductus arteriosus, intraventricular haemorrhage, and packed red-cell transfusion were more frequent among neonates who developed ROP. RDS was present in 57 of 72 infants with ROP (79.2%) compared with 112 of 228 infants without ROP (49.1%; P<0.001). Supplemental oxygen was required in 68 infants with ROP (94.4%) compared with 169 infants without ROP (74.1%; P<0.001). Mechanical ventilation was required in 41 (56.9%) and 60 (26.3%) infants in the ROP and no-ROP groups, respectively (P<0.001). Culture-positive sepsis was observed in 27 infants with ROP (37.5%) compared with 39 without ROP (17.1%; P<0.001), while PRBC transfusion was required in 29 (40.3%) and 38 (16.7%) infants, respectively (P<0.001). Multiple gestation and antenatal corticosteroid exposure were not significantly associated with ROP. Table 5. Comparison of neonatal and perinatal factors between ROP and no-ROP groups Variable ROP (n=72) No ROP (n=228) P value RDS 57 (79.2%) 112 (49.1%) <0.001 Surfactant administration 42 (58.3%) 74 (32.5%) <0.001 Supplemental oxygen 68 (94.4%) 169 (74.1%) <0.001 Mechanical ventilation 41 (56.9%) 60 (26.3%) <0.001 Apnea of prematurity 24 (33.3%) 35 (15.4%) 0.001 Culture-positive sepsis 27 (37.5%) 39 (17.1%) <0.001 PDA 17 (23.6%) 31 (13.6%) 0.043 IVH 13 (18.1%) 17 (7.5%) 0.009 PRBC transfusion 29 (40.3%) 38 (16.7%) <0.001 Multiple gestation 15 (20.8%) 34 (14.9%) 0.236 Antenatal corticosteroid exposure 46 (63.9%) 161 (70.6%) 0.282 Univariable analysis of risk factors for ROP On univariable analysis, RDS, surfactant administration, supplemental oxygen exposure, mechanical ventilation, apnea of prematurity, culture-positive sepsis, PDA, IVH, and PRBC transfusion were significantly associated with ROP. The strongest crude association was observed with supplemental oxygen exposure (OR 5.93; 95% CI 2.07–16.98), followed by RDS (OR 3.94; 95% CI 2.11–7.35), mechanical ventilation (OR 3.70; 95% CI 2.13–6.43), and PRBC transfusion (OR 3.37; 95% CI 1.88–6.06). Table 6. Univariable analysis of factors associated with ROP Risk factor Crude OR 95% CI P value RDS 3.94 2.11–7.35 <0.001 Surfactant administration 2.91 1.69–5.02 <0.001 Supplemental oxygen 5.93 2.07–16.98 <0.001 Mechanical ventilation 3.70 2.13–6.43 <0.001 Apnea of prematurity 2.76 1.50–5.06 0.001 Culture-positive sepsis 2.91 1.61–5.24 <0.001 PDA 1.96 1.01–3.81 0.043 IVH 2.73 1.26–5.95 0.009 PRBC transfusion 3.37 1.88–6.06 <0.001 Multiple gestation 1.50 0.76–2.95 0.236 Antenatal corticosteroid exposure 0.74 0.42–1.29 0.282 Treatment requirement and outcomes Of the 72 infants diagnosed with ROP, 18 (25.0%) required active treatment, corresponding to 6.0% of the entire study population. Among these, 11 infants (61.1%) underwent laser photocoagulation, 5 (27.8%) received intravitreal anti-VEGF therapy, and 2 (11.1%) received combined or sequential therapy. Following initial treatment, regression was documented in 16 of 18 infants (88.9%). Two infants (11.1%) had persistent or reactivated disease requiring additional treatment. One infant (5.6%) showed progression despite initial therapy. No infant progressed to Stage 5 retinal detachment. Table 7. Treatment and outcomes among infants with treatment-requiring ROP Treatment/outcome n (%) (n=18) Laser photocoagulation 11 (61.1%) Intravitreal anti-VEGF therapy 5 (27.8%) Combined/sequential therapy 2 (11.1%) Regression following initial treatment 16 (88.9%) Persistent/reactivated disease 2 (11.1%) Retreatment required 2 (11.1%) Progression despite initial treatment 1 (5.6%) Stage 5 retinal detachment 0

The present study evaluated ROP among 300 neonates born at less than 32 completed weeks of gestation in a tertiary-care NICU. In the current working dataset, ROP was identified in 72 infants, corresponding to a prevalence of 24.0%. The principal findings were the marked increase in ROP with decreasing gestational age and birth weight, the higher frequency of several markers of neonatal illness among infants with ROP, and the relatively favourable documented outcome among infants who underwent treatment. The observed ROP prevalence of 24.0% lies within the range reported by several Indian tertiary-care studies, although substantial inter-study variation is evident. Rao et al. reported any ROP in 21.6% of 282 infants, while Chaudhari et al. reported an incidence of 22.3% among 552 screened infants.[6,11] These estimates are close to the present working value. Goyal et al. reported ROP in 25.36% of infants participating in a large NICU-based screening programme, again broadly comparable to the present cohort.[7] In contrast, Rachamadugu et al. reported a considerably lower incidence of 10.25% among 400 screened infants in a level-3 NICU in Telangana.[10] The range becomes still wider when other Indian cohorts are considered. Hungi et al. reported ROP in 41.5% of infants screened in a rural South Indian NICU, whereas the recent study by Kumaresan et al. from Chennai reported ROP in only 5.1% of 375 infants.[12,9] Lekha et al., studying a deliberately high-risk population restricted to extreme preterm infants or those with extremely low birth weight, observed any ROP in 87% of 54 infants.[13] These differences emphasize that crude ROP percentages cannot be compared without considering gestational-age limits, birth-weight eligibility, neonatal survival, referral pattern, screening completeness and the proportion of extremely immature infants represented in each cohort. The strong inverse relationship between gestational age and ROP in the present working dataset is biologically and clinically consistent with previous reports. ROP occurred in 53.3% of infants born before 28 weeks, compared with 29.5% among those born at 28-29+6 weeks and 12.5% among those born at 30-31+6 weeks. Similarly, ROP was observed in 50.9% of infants weighing below 1000 g, falling to 22.4% in infants weighing 1000-1499 g and 8.8% in those weighing ≥1500 g. Rao et al. found increasing incidence and severity of ROP with decreasing gestational age and birth weight, with birth weight below 1250 g retaining significance for any ROP in multivariable analysis.[6] Maini et al. likewise reported low gestational age and low birth weight as independent determinants of severe ROP.[14] The high burden among the most immature infants is further supported by Lekha et al., who restricted their analysis to infants with gestational age ≤28 weeks or birth weight ≤1000 g and documented any ROP in 87% and treatment-requiring ROP in 19.14%.[13] The contrast between that highly selected cohort and the overall 24.0% prevalence in the present <32-week cohort illustrates the importance of the underlying risk distribution when interpreting institutional ROP rates. In the present working dataset, respiratory distress syndrome, surfactant administration, oxygen exposure, mechanical ventilation, apnea, culture-positive sepsis, PDA, IVH and PRBC transfusion were more frequent in infants who developed ROP. These findings should be interpreted as associations rather than proof of causation, because many of these exposures are closely linked to the severity of prematurity and neonatal illness. In particular, infants with lower gestational age and birth weight are simultaneously more likely to develop ROP and to require prolonged respiratory support, transfusion and intensive care. The association with oxygen and respiratory support is consistent with several Indian studies. In the present analysis, supplemental oxygen exposure was observed in 94.4% of the ROP group compared with 74.1% of infants without ROP, while mechanical ventilation was required in 56.9% and 26.3%, respectively. Rachamadugu et al. identified oxygen requirement among the variables associated with ROP, while Chaudhari et al. reported oxygen therapy, septicemia and apnea as important associated factors.[10,11] Goyal et al. demonstrated that infants with more severe type 1 ROP had greater oxygen requirement and longer ventilation exposure than those with less severe disease.[7] These observations do not imply that clinically indicated oxygen should be withheld. Rather, they reinforce the importance of carefully monitored oxygen administration and recognition that prolonged respiratory support is also a marker of underlying neonatal severity. The relationship between oxygen and ROP is therefore best interpreted within the broader context of prematurity, illness severity and cumulative neonatal exposure rather than as an isolated causal factor. Sepsis also showed an important association in the present working dataset, occurring in 37.5% of infants with ROP compared with 17.1% without ROP. Rachamadugu et al. reported clinical sepsis as significant on univariate analysis, although it did not remain an independent predictor after multivariable adjustment.[10] Chaudhari et al. similarly identified septicemia as an important factor associated with ROP.[11] These findings support the concept that systemic inflammatory illness may accompany an increased probability of ROP, but residual confounding by gestational maturity and overall neonatal illness must be considered. Packed red-cell transfusion was also more common among infants with ROP in the current analysis. Goyal et al. reported a higher number of blood transfusions in type 1 compared with type 2 ROP, with transfusion burden remaining significant in their multivariable analysis.[7] Maini et al. reported blood transfusion as independently associated with severe ROP in their cohort.[14] Rao et al., however, found PRBC transfusion significant on univariate analysis but not as an independent predictor after multivariable adjustment.[6] The variation between studies demonstrates the importance of adjustment for prematurity, anemia and severity of illness before attributing an independent role to transfusion itself. Intraventricular haemorrhage was identified more frequently in the ROP group in the present working dataset. This observation is noteworthy because Rao et al. found IVH to be the only independent predictor of severe ROP in their multivariable model.[6] Nevertheless, the number of IVH events in individual studies is often relatively small, and its relationship with ROP may partly reflect the common underlying influence of extreme prematurity and systemic instability. Multiple gestation and antenatal corticosteroid exposure were not significantly associated with ROP in the present working analysis. Rao et al. similarly reported no significant association for multiple gestation or antenatal steroid exposure.[6] Maini et al. observed an apparent association between antenatal betamethasone and less severe ROP on univariate analysis, but this did not persist after multivariable adjustment.[14] These findings suggest that maternal and antenatal factors need to be interpreted cautiously and in the context of neonatal maturity and postnatal course. With respect to disease severity, Stage 1 constituted the largest group in the current working dataset, followed by Stage 2 and Stage 3 disease. Rachamadugu et al. reported an even greater predominance of mild disease, with 92.6% of affected infants having Stage 1 ROP and 7.3% having Stage 2 disease, with no advanced stages reported.[10] Le et al. similarly found Stage 1 to be the predominant presentation, whereas Kumaresan et al. reported only Stage I and II disease in their recent cohort.[8,9] Differences in stage distribution may reflect screening timing, case mix, referral pathways and neonatal survival. In the present working dataset, 18 of 72 infants with ROP (25.0%) required treatment, corresponding to 6.0% of the total study cohort. Treatment requirements have varied widely between Indian reports. Rachamadugu et al. treated only 3 of 41 affected infants (7.3%), whereas Rao et al. reported severe treatment-requiring ROP in 6.7% of their entire cohort.[10,6] Chaudhari et al. reported that 41 of 123 infants with ROP (33.6%) required laser photocoagulation.[11] Hungi et al. reported treatable ROP in 10.2% of all screened eyes and 26.4% of eyes diagnosed with ROP.[12] These figures should not be compared directly without recognizing that some studies report outcomes per infant and others per eye. The documented treatment outcome in the present working cohort was generally favourable, with regression following initial treatment in 88.9% and retreatment required in two infants. Previous Indian studies have also reported favourable anatomical outcomes with timely treatment. Rao et al. documented regression in all 19 infants treated with laser, while Le et al. reported successful initial regression following laser treatment, with one infant subsequently requiring repeat photocoagulation.[6,8] Goyal et al. reported generally favourable outcomes after treatment, although a small number of eyes with aggressive posterior disease progressed despite therapy.[7] Hungi et al. reported favourable outcomes in all treated eyes in their rural cohort.[12] The present findings therefore reinforce two clinically important observations. First, the burden of ROP is concentrated disproportionately among infants with lower gestational age and birth weight. Second, several markers of severe neonatal illness—including respiratory support, sepsis and transfusion—cluster among infants who develop ROP. These variables should not be interpreted independently of prematurity, but they can help identify infants who warrant particularly careful adherence to screening and follow-up. A strength of the present study is its focus on a clearly defined cohort of neonates born at less than 32 weeks of gestation over a contemporary 12-month period in a tertiary-care NICU. The simultaneous assessment of disease frequency, neonatal clinical factors, ROP severity, treatment requirement and documented outcomes provides a clinically integrated representation of ROP in this high-risk population. The study also has limitations. Its retrospective design depends on the completeness and consistency of routinely recorded neonatal and ophthalmological data. Quantitative measures such as cumulative oxygen exposure, exact FiO₂, duration of respiratory support, number of transfusions and longitudinal ophthalmological follow-up may not have been uniformly available for every infant. Because several neonatal exposures are strongly correlated with gestational age and severity of illness, unadjusted associations may reflect confounding. Multivariable analysis based on the final patient-level dataset is therefore important before specific factors are described as independent predictors. Longer-term visual, refractive and neurodevelopmental outcomes were beyond the scope of the present study. In conclusion, ROP constituted an important morbidity among neonates born before 32 weeks of gestation in this tertiary-care NICU. Lower gestational age and birth weight were strongly associated with ROP, while respiratory morbidity, oxygen exposure, mechanical ventilation, sepsis, IVH and blood transfusion occurred more frequently among affected infants. Most disease was detected at earlier stages, and the documented anatomical response among treated infants was generally favourable. These findings support systematic ROP screening, careful neonatal monitoring and coordinated follow-up between neonatology and ophthalmology services, particularly for the most immature and clinically vulnerable infants.

Retinopathy of prematurity was an important morbidity among neonates born at less than 32 weeks of gestation in this tertiary-care NICU. Lower gestational age and lower birth weight showed strong associations with ROP, while respiratory morbidity, oxygen exposure, mechanical ventilation, sepsis, intraventricular haemorrhage, and packed red-cell transfusion were more frequent among affected infants. Most cases were identified in the earlier stages of disease, and treatment outcomes were generally favourable among infants who received timely intervention. These findings support strict adherence to ROP screening and follow-up protocols, with particular attention to extremely preterm, extremely low-birth-weight, and clinically unstable neonates. Limitations 1. The retrospective design limited the study to information available in routinely maintained neonatal and ophthalmological records. 2. Quantitative details regarding cumulative oxygen exposure, maximum FiO₂, duration of respiratory support, number of blood transfusions, and some laboratory parameters may not have been uniformly available in all neonates. 3. Some neonatal exposures are closely related to the severity of prematurity and illness; therefore, unadjusted associations should not be interpreted as causal relationships. 4. The study was conducted at a single tertiary-care centre, which may limit direct generalization of the findings to other neonatal-care settings. 5. Long-term visual, refractive, and neurodevelopmental outcomes were beyond the scope of the present study. Strengths of the Study 1. The study evaluated a clearly defined high-risk population of neonates born at less than 32 weeks of gestation. 2. A contemporary 12-month cohort from a tertiary-care NICU was analysed. 3. The study assessed demographic variables, neonatal clinical factors, ROP characteristics, treatment requirement, and documented outcomes within the same cohort. 4. Contemporary ROP classification terminology was incorporated wherever permitted by the available records. 5. The study provides region-specific data from a tertiary-care centre in the Rayalaseema region of Andhra Pradesh.

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