Can red cell indices predict retinopathy of prematurity in preterm extreme low birth weight neonates? A single center retrospective study

Reashma Roshan, Mubashir H. Shah


Background: Improvement in neonatal health care services has led to the survival of extreme low birth weight babies over the years. This has led to increased number of retinopathy of prematurity (ROP) cases being diagnosed. Thus it becomes imperative to identify factors which can reliably predict preterm neonates at increased risk of ROP. Aims and objectives were to identify red cell indices at 4 weeks postpartum which can predict ROP in extreme low birth weight neonates.

Methods: Three years ROP data in extremely low birth weight neonates was retrospectively collected and analyzed.

Results: The mean gestational age at birth of the neonates in ROP group (n=149) and no-ROP group (n=191) was 28.25 (±2.71) weeks and 31.82 (±2.24) weeks, respectively (p<0.05). The mean birth weight of the neonates in ROP group and no-ROP group was 756.44 (±95.50) grams and 890 (±109.20) grams, respectively (p<0.05). In extremely low birth weight (ELBW) neonates, hematologic parameters such as hemoglobin, hematocrit, red blood cells, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration values were lower and white blood cell count was higher in ROP group as compared to no-ROP group (p<0.05).

Conclusions: Red cell indices may predict which extreme low birth weight neonates are at increased risk of developing retinopathy of prematurity. Being easily and widely available, red cell indices can be used as a screening test to predict ROP.


Retinopathy of prematurity, Red cell indices, Preterm, Extreme low birth weight

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O’Connor AR, Stephenson T, Johnson A, Tobin MJ, Moseley MJ, Ratib S, et al. Long-Term Ophthalmic Outcome of Low Birth Weight Children With and Without Retinopathy of Prematurity. Pediatrics. 2002;109:12-8.

Zin A, Gole GA. Retinopathy of prematurity-incidence today. Clin Perinatol. 2013;40:185-200.

Bas AY, Koc E, Dilmen U. ROP Neonatal Study Group. Incidence and severity of retinopathy of prematurity in Turkey. Br J Ophthalmol. 2015;99:1311-4.

Kurtul BE, Kabatas EU, Zenciroglu A, Ozer PA, Ertugrul GT, Beken S, et al. Serum neutrophil-to-lymphocyte ratio in retinopathy of prematurity. JAAPOS. 2015;19:327-31.

Tao Y, Dong Y, Lu CW, Yang W, Li Q. Relationship between mean platelet volume and retinopathy of prematurity. Graefes Arch Clin Exp Ophthalmol. 2015;253:1791-4.

Jensen AK, Ying GS, Huang J, Karp K, Quinn GE, Binenbaum G. Thrombocytopenia and retinopathy of prematurity. JAAPOS. 2011;15:3-4.

Lubetzky R, Stolovitch C, Dollberg S, Mimouni FB, Salomon M, Mandel D. Nucleated red blood cells in preterm infants with retinopathy of prematurity. Pediatrics. 2005;116:619-22.

Niranjan HS, Bharath Kumar Reddy KR, Benakappa N, Murthy K, Shivananda S, Veeranna V. Role of hematological parameters in predicting retinopathy of prematurity (ROP) in preterm neonates. Indian J Pediatr. 2013;80:726-30.

An International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005;123:991-9.

Early Treatment for Retinopathy of Prematurity Cooperative Group. Results of the early treatment for retinopathy of prematurity randomized trial: revised indications for the treatment of retinopathy of prematurity. Arch Ophthalmol. 2003;121:1684-96.

Henry E, Christensen RD. Reference intervals in neonatal hematology. Clin Perinatol. 2015;42:483-97.

Butcher JT, Johnson T, Beers J, Columbus L, Isakson BE. Hemoglobin alpha in the blood vessel wall. Free Radic Biol Med. 2014;73:136-42.

Frost MT, Wang Q, Moncada S, Singer M. Hypoxia accelerates nitric oxide-dependent inhibition of mitochondrial complex I in activated macrophages. Am J Phisiol Regul Integr Comp Physiol. 2005;288:394-400.

Yau GSK, Lee JWY, Tam VTY, Yip S, Cheng E, Liu CC, et al. Incidence and risk factors for retinopathy of prematurity in multiple gestations; a Chinese population study. Medicine. 2015;94:867.

Banerjee J, Asamoah FK, Singhvi D, Kwan AW, Morris JK, Aladangady N. Haemoglobin level at birth is associated with short term outcomes and mortality in preterm infants. BMC Med. 2015;27:16.

Ashki N, Chan AM, Wang W, Kiyohara M, Lin L, Braun J, et al. Peroxynitrite upregulates angiogenic factors VEGF-A, BFGF, and HIF1 alpha in human corneal limbal epithelial cells. Invest Ophthalmol Vis Sci. 2014;55:1637-46.

Italiano JE, Richardson JL, Patel-Hett S, Battinelli E, Zaslavsky A, Short S, et al. Angiogenesis is regulated by a novel mechanism: pro-and anti-angiogenic proteins are organized into separate platelet α granules and differentially released. Blood. 2008;111:1227-33.

Folkman J. Angiogenesis: an organising principle for drug discovery? Nat Rev Drug Discov. 2007;64:273-86.