Relationship Between Retinopathy of Prematurity and Anemia and Red Blood Cell Transfusions in Very Premature/Very-Low-Birth-Weight Neonates

Aim: Retinopathy of prematurity (ROP) is the leading cause of blindness in preterm infants. In this study, we evaluated the potential role of anemia and packed red blood cell (RBC) transfusions as risk factors in ROP development. Methods: A retrospective cohort study was conducted on premature infants who met the following inclusion criteria: infants with gestational age (GA) ≤ 32 weeks and very low birth weight (VLBW) who were admitted to the Neonatology-Preterm Department of Emergency Pediatric Hospital Cluj-Napoca during a two-year period (from 1 January 2023 to 31 December 2024). We investigated differences in the following perinatal characteristics between the two groups, those with ROP and those without: GA, birth weight (BW), severe respiratory distress syndrome, early-onset and late-onset sepsis, hemoglobin (Hb) levels, and RBC transfusions. We used the statistically significant variables to perform binary logistic regression. Results: A total of 124 newborns were recruited, with the following inclusion criteria: GA ≤ 32 weeks and BW ≤ 1500 g, of whom 79 received at least one RBC transfusion prior to 36 weeks corrected GA. Of them, 48 developed ROP with an incidence of 38.7%. In 20 cases, ROP required treatment. To adjust for clinical illness, a binary logistic regression model was created, including known risk factors for ROP and illness severity (GA, severe respiratory distress syndrome, and early- and late-onset sepsis) that were closely related to the risk of ROP development. For this regression model, Nagelkerke R-squared = 0.358, p < 0.001, and the AOR was 4.812 (95% CI: 1.374–16.847). Conclusions: RBC transfusions increased the risk of ROP.