Risk factors for severe retinopathy of prematurity stratified by birth weight and gestational age in privately insured infants.

Purpose: To evaluate risk factors associated with severe retinopathy of prematurity ROP (sROP) in two separate cohorts of infants.

Methods: We performed a retrospective study of the Merative MarketScan Commercial Database between 2003 and 2022. Infants with ROP were stratified into two cohorts: group A (defined as infants with both birth weight [BW] <1000 g and gestational age [GA] <29 weeks) and group B (defined as infants with either BW ≥1000 g or GA ≥29 weeks). Infants with sROP were defined as those who received treatment for ROP. Outpatient and inpatient claims using International Classification of Diseases and Current Procedural Terminology codes were used to identify neonatal comorbidities. Multivariable logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for sROP requiring treatment with respect to various comorbidities.

Results: A total of 425 of 8,789 infants with ROP developed sROP (4.8%). We identified 2,726 infants in group A, of whom 387 (14.2%) required a procedure, and 6,063 in group B, of whom 38 (0.6%) required a procedure. In group A, intraventricular hemorrhage (OR = 1.38; 95% CI, 1.09-1.74) and patent ductus arteriosus ligation (OR = 1.65; 95% CI, 1.25-2.16) were the comorbidities that significantly increased the odds of sROP on multivariable analysis. In group B, infection (OR = 1.96; 95% CI, 1.01-3.80) was the only comorbidity that significantly increased the adjusted odds of sROP.

Conclusions: Risk factors for sROP may differ between smaller and larger infants. Infection may serve as an important risk factor for ROP progression amongst larger infants due to its connection with poor postnatal growth.