Pediatrics World Conference 2026

Abstract

Background:
Retinopathy of prematurity (ROP) remains a leading cause of preventable childhood blindness worldwide [1,2]. Aggressive posterior retinopathy of prematurity (APROP) is a severe, rapidly progressive form of ROP that can result in irreversible visual loss if not promptly recognized and treated [3,4]. Although APROP has been widely studied in high-income countries, local data from low- and middle-income settings such as the Philippines remain limited [5]. Variations in neonatal care, infection control, and screening practices may influence disease severity and outcomes [6].

Objective:
To identify factors associated with aggressive posterior retinopathy of prematurity among preterm infants diagnosed with ROP at a tertiary government hospital in the Philippines.

Methodology:
This retrospective case–control study was conducted at Southern Philippines Medical Center in Davao City, Philippines. Medical records of preterm infants diagnosed with ROP between January 2015 and December 2024 were reviewed. A total of 156 infants were included, of whom 26 (16.7%) were classified as APROP cases, and 130 infants with Stage 1–3 ROP served as controls. Maternal, perinatal, and postnatal characteristics were extracted from hospital records. Firth’s logistic regression was used to reduce bias related to small sample size and rare outcomes. The primary outcome was the occurrence of APROP and its association with selected risk factors.

Results:
Most maternal and perinatal variables, including maternal age, adequacy of prenatal care, gestational age, and birth weight, were not significantly associated with APROP. On univariable analysis, maternal hyperthyroidism (OR = 8.81, 95% CI 1.11–69.80, p = 0.039) and neonatal culture positivity (OR = 2.37, 95% CI 1.02–5.50, p = 0.045) were significantly associated with APROP. After multivariable adjustment using Firth’s correction, only culture positivity remained independently associated with APROP (adjusted OR = 2.37, 95% CI 1.02–5.50, p = 0.045). Infants with positive blood cultures had more than twice the odds of developing APROP. Notably, none of the APROP cases progressed to total blindness during follow-up.

Conclusions:
Neonatal sepsis, reflected by culture positivity, was the sole independent risk factor associated with APROP in this cohort. These findings underscore the importance of 
infection prevention, early detection, and timely ophthalmologic referral in reducing severe ROP outcomes. Multicenter prospective studies are warranted to validate these findings and guide improvements in neonatal care practices.