Neonatal retinal hemorrhage and retinopathy of prematurity: a critical review of current practices and future directions

Neonatal retinal hemorrhage (RH) and retinopathy of prematurity (ROP) are significant causes of visual impairment in preterm infants, necessitating effective diagnostic and therapeutic strategies. This review synthesizes current approaches to RH and ROP management, highlighting their limitations and the critical need for standardized diagnostic criteria. Indirect ophthalmoscopy, while accessible, suffers from subjective variability, whereas wide-field digital retinal imaging, despite superior visualization, is limited by cost and training requirements. Vaginal delivery and prematurity-related factors, such as fragile retinal vasculature and neonatal complications (e.g., sepsis and hyperbilirubinemia), significantly increase RH and ROP risk, with severe RH correlating with ROP progression. Advances in digital retinal imaging and artificial intelligence (AI) offer promising solutions for early detection, enabling timely interventions such as anti-VEGF therapy to improve visual outcomes. Future directions include developing universal diagnostic standards, exploring novel treatments such as probiotics, and leveraging technologies such as optical coherence tomography. Enhanced screening programs, collaborative research, and public awareness are essential to optimize RH and ROP management, ultimately improving long-term visual prognosis for affected infants.