Retinopathy of prematurity as a clinical marker of developmental vulnerability in preschool children: A nationwide Korean Health Screening study

Purpose To determine the Retinopathy of prematurity (ROP) and its association with developmental delay in Korean preschool children. Methods We conducted a nationwide cohort study using the Korean National Health Insurance Service and National Health Screening Program for Infants and Children (NHSPIC). The study included 808,536 children born 2014–2018 who completed the 7th NHSPIC screening at 54–60 months. Development assessed by the Korean Developmental Screening Test (K-DST) in six domains (self-care, cognition, language, fine motor, gross motor, and sociality. Subnormal visual acuity (VA) was defined as <0.6 (or 0.63) in either eye. Multivariable logistic regression estimated adjusted odds ratios (ORs) for developmental delay. Results Of 808,536 children, 7,428 (0.92%) had a history of ROP. Children with ROP had lower birth weight and gestational age and higher frequencies of maternal complications and subnormal presenting VA. After adjustment for available maternal and child covariates, ROP was associated with higher odds of developmental delay across several domains, with adjusted ORs ranging from 1.35 for cognition (95% CI: 1.00–1.81) to 1.56 for gross motor development (95% CI: 1.18–2.07). In analyses stratified by ROP and presenting VA status, children. Conclusions Children with a history of ROP showed higher odds of developmental delay at 54–60 months, especially when subnormal presenting visual acuity was also present. ROP may serve as a clinically useful marker of prematurity-related developmental vulnerability, supporting integrated ophthalmic and developmental surveillance before school entry.