780 - Clinical Predictors and Outcomes of Treatment for Severe Retinopathy of Prematurity in a Modern Cohort of Extremely Premature Infants (≤25 Weeks GA)

Publication Number: 2761.780

Devin Beckman, Hackensack Meridian School of Medicine, Cranford, NJ, United States; Tara Lozy, Hackensack Meridian School of Medicine, Hackensack, NJ, United States; Suraj Bala, Hackensack Meridian School of Medicine, Richmond, VA, United States; Harry M. Engel, Albert Einstein College of Medicine, New York, NY, United States; Marwa Khalil, Hackensack Meridian School of Medicine, hackensack, NJ, United States

Background: Extremely premature infants (≤25 weeks gestational age [GA] or ≤500 g birthweight) represent a high-risk population for severe retinopathy of prematurity (ROP), yet data on disease progression and outcomes are limited. We aimed to characterize the onset, treatment, and risk factors for severe ROP in this vulnerable cohort.

Objective: Characterize the onset, progression, treatment outcomes, and clinical risk factors for severe retinopathy of prematurity (ROP) in a retrospective cohort of extremely premature infants (≤25 weeks gestational age or ≤500g birthweight)

Design/Methods: This retrospective study reviewed infants ≤25 weeks GA or ≤500 g birthweight admitted to a regional academic neonatal intensive care unit between December 2020 and August 2024. We analyzed outcomes for all infants who developed any stage of ROP.

Results: The cohort included 35 infants (70 eyes) who developed ROP. A high proportion, 61.4% (43 eyes), progressed to require treatment with either intravitreal bevacizumab (IVB) or laser photocoagulation. The median postmenstrual age (PMA) at first treatment was 36 weeks, with no infant requiring treatment before 34 weeks PMA. While not statistically significant (p=0.248), retreatment rates were numerically lower for eyes initially treated with IVB (18.8%) compared to laser (36.4%). Traditional metrics like birthweight and weight gain did not predict treatment need (p=0.900). However, culture-proven sepsis, being small for gestational age, and exposure to steroids or CPAP were associated with needing treatment, showing medium-to-large effect sizes (SMD 0.6-0.8). All followed eyes achieved complete ROP resolution

Conclusion(s): Extremely premature infants ≤25 weeks GA are at high risk for severe ROP, with nearly two-thirds requiring intervention. Current screening recommendations at 31 weeks PMA remain appropriate and begin before the development of Type 1 ROP. Although not statistically significant, our findings suggest a trend toward lower retreatment rates with IVB as a primary therapy. Identified clinical risk factors beyond traditional weight-based criteria, such as sepsis and SGA, and postnatal steroids, may improve early identification of infants requiring intervention, though validation in larger cohorts is essential.