TOP 57 - Impact of Intrauterine Growth Restriction on Retinopathy of Prematurity Severity in Preterm Infants- A Retrospective Cohort Study

Publication Number: 4761.TOP 57

NAURI E. ABREU, University of Illinois College of Medicine, Chicago, IL, United States; De-Ann Pillers, University of Illinois Chicago, Chicago, IL, United States; Alan Schwartz, University of Illinois College of Medicine, Chicago, IL, United States; Zaynab Kadhem, Children's Hospital of the University of Illinois, Chicago, IL, United States; Erva Gulseven, University of Illinois Chicago, Naperville, IL, United States

Background: Retinopathy of prematurity (ROP) is a leading cause of preventable childhood blindness. Its risk is strongly associated with low gestational age, low birth weight, and oxygen exposure. Intrauterine growth restriction (IUGR) has been identified as an additional risk factor, possibly predisposing infants to more severe ROP through impaired fetal vascular development and oxidative stress vulnerability. Limited data, however, have examined whether this relationship differs by race, particularly among Black preterm infants, who experience disproportionate rates of adverse neonatal outcomes. Understanding the interaction between race and IUGR is essential to refine ROP screening strategies and improve health equity in preterm care.

Objective: To determine whether preterm infants with IUGR have a higher incidence and severity of ROP, including treatment-requiring disease, compared with non-IUGR infants; and to assess whether, among Black preterm infants, IUGR remains an independent predictor of ROP incidence and severity after adjustment for gestational age, birth weight, and oxygen exposure.

Design/Methods: We are conducting a single-center retrospective cohort study of preterm infants admitted to the University of Illinois Health NICU between 2010 and 2024 with birth weight ≤1500 g or gestational age ≤32 weeks. Demographic, perinatal, and neonatal data are abstracted from the electronic medical record and REDCap database. IUGR is defined as birth weight < 10th percentile for gestational age and sex. Primary outcomes include any ROP, severe ROP (Stage ≥3 or any plus disease), and treatment-requiring ROP. Exploratory analyses evaluate differences in postmenstrual age at ROP onset between IUGR and non-IUGR infants. Group comparisons are performed using χ² or Fisher's exact tests, and continuous variables with t- or Wilcoxon tests as appropriate; multivariable logistic regression will examine the independent association of IUGR with ROP incidence and severity after controlling for gestational age, birth weight, and oxygen exposure.
Preliminary data from 41 infants (87% Black; 12% IUGR) show ROP in 55%, severe ROP in 5%, and treatment-requiring disease in 0%.
Timeline: we will extract and quality-check an additional ~160-500 eligible infants with rolling pulls and validation through December 10, 2025, target data lock on December 12, 2025, and complete final adjusted analyses by mid-December 2025 (≈December 15)-substantially increasing power and improving the relevance and generalizability of our results.

Patient Characteristics Summary
Baseline characteristics of 41 preterm infants ≤1500 g: 70.7% male, 12.2% Hispanic/Latino, 87.8% Black or African American; mean GA 28.9 ± 3.0 weeks (23.4-34.0), birth weight 1100.8 ± 308 g (460-1480), length 36.2 ± 3.46 cm (29-43), Apgar 1 min 5.17 ± 2.24 and 5 min 7.27 ± 1.55; any ROP 56.1%.

ROP exam
ROP exam illustration[image on Iridex Physician Education website]

REDCap
Secure web application for building and managing online surveys and databases