Postnatal Weight Gain and Severe Retinopathy of Prematurity in Very Low Birth Weight Infants: A Retrospective Study

Introduction: Retinopathy of prematurity (ROP) is a well-known cause of childhood visual loss. While most cases regress spontaneously, severe ROP can cause permanent vision loss. Known risk factors include low birth weight (LBW), low gestational age, and sepsis. This study investigates the association between poor postnatal weight gain (WG) (g/kg/day) at 2-week intervals up to 8 weeks and severe ROP requiring treatment in infants ≤32 weeks and very LBW (VLBW). Methods: A retrospective review included VLBW infants (≤1500 g, ≤32 weeks) admitted to a neonatal intensive care unit in Saudi Arabia (2021–2024). Demographic data and ROP risk factors were collected. Severe ROP (requiring laser treatment) was the primary outcome. Relative WG was calculated at 2, 4, 6, and 8 weeks postnatal. Results: Of 52 infants (7.5%) with severe ROP, WG at all intervals was significantly lower than in the no ROP/regression group ( P = 0.007–0.04). Infants with WG <7.7 g/kg/day had the highest risk (sensitivity 75%, specificity 38.1%). Logistic regression identified poor WG in the first 2 weeks and prolonged mechanical ventilation as independent risk factors ( P = 0.006 and P = 0.011, respectively). Conclusions: Poor WG in the first 2 weeks is an independent predictor of severe ROP. Close monitoring of early postnatal growth in preterm infants may aid in early risk stratification and intervention.