Retinopathy of Prematurity Among Small for Gestational Age and Appropriate for Gestational Age Preterm Infants: A Tertiary Care-based Comparative Study from Western India

Background Retinopathy of prematurity (ROP) is a major cause of preventable childhood blindness. Although the association between birth weight (BW), gestational age, and ROP is well established, most Indian studies originate from central and southern regions, with limited data from western India. Purpose To compare the incidence, severity, and risk factors of ROP in small for gestational age (SGA) versus appropriate for gestational age (AGA) premature infants in western India. Methods A prospective cohort study was conducted in the Neonatal Intensive Care Unit of a medical college in western India over 18 months (August 2022-January 2024). A total of 653 preterm infants were screened, including 383 AGA and 270 SGA infants. Results The overall incidence of ROP was 16.38%. ROP developed in 17.7% of SGA infants and 15.4% of AGA infants, with no significant difference ( P = .428). Subgroup analysis showed higher ROP occurrence in SGA infants at 29-31 weeks gestation ( P = .0086) and in the ≤1,000 g birth-weight group ( P = .035). However, SGA status was not an independent predictor in multivariable logistic regression (AOR 1.18, 95% CI 0.77-1.82, P = .431). BW ≤1,000 g and gestational age 29-31 weeks were significant predictors. Conclusion The overall ROP incidence was 16.38%, with no significant difference between SGA and AGA infants. Higher risk was observed in infants with gestational age 29-31 weeks and BW ≤1,000 g, supporting screening based primarily on prematurity and very low BW rather than growth status alone.