Evaluation of the frequency, risk factors and outcomes of ROP in preterm infants with a BW >1500 g or GA >32 weeks in Turkiye (TR-ROP 2) and medicolegal fears: a Turkish Neonatal Society multicentre study

Background This study aimed to evaluate the prevalence and risk factors of retinopathy of prematurity (ROP) in preterm infants with a birth weight (BW)>1500 g or gestational age (GA) >32 weeks in Turkiye. Methods A prospective cohort study (TR-ROP 2) was conducted in 80 neonatal intensive care units between 30 September 2023 and 1 November 2024. Infants with a BW >1500 g or GA >32 weeks who had an unstable clinical course or were deemed at risk for ROP were included. The effect of medicolegal concerns on the decision to screen was also evaluated. Results The study included 4140 infants at risk for ROP development; 242 (5.8%) developed any stage of ROP, and 17 (0.4%) developed severe ROP requiring treatment. Risk factors independently associated with ROP included lower GA and BW, being small for GA, red blood cell transfusion, oxygen therapy >5 days, mechanical ventilation >1 day, early neonatal sepsis (ENS) with comorbidities or presence of ≥3 comorbidities (excluding ENS). Of those with BW ≥2000 g, 31.4% were screened for medicolegal reasons; 2.2% developed ROP, but none had severe ROP. Conclusions ROP in mature infants is rare but can occur in the presence of multiple risk factors. Medicolegal concerns may contribute to overscreening. Developing evidence-based, risk-adapted screening guidelines is essential to ensure appropriate care without unnecessary interventions.