Am J Perinatol
DOI: 10.1055/a-2297-8644
Original Article

Clinical and Growth Correlates of Retinopathy of Prematurity in Preterm Infants with Surgical Necrotizing Enterocolitis and Intestinal Perforation

Parvesh M. Garg
1   Department of Pediatrics/Neonatology, Atrium Health Wake Forest Baptist, Wake Forest School of Medicine, Winston Salem, North Carolina
2   Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
Robin A. Riddick
2   Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
Md A.Y. Ansari
3   Department of Data Sciences, University of Mississippi Medical Center, Jackson, Mississippi
Asha C. Meilstrup
2   Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
David Zepponi
2   Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
Andrea Smith
2   Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
Nils Mungan
4   Department of Ophthalmology, University of Mississippi Medical Center, Jackson, Mississippi
Jeffrey Shenberger
5   Department of Pediatrics/Neonatology, Connecticut Children's, Hartford, Connecticut
William B. Hillegass
3   Department of Data Sciences, University of Mississippi Medical Center, Jackson, Mississippi
6   Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
Padma P. Garg
2   Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi
› Author Affiliations
Funding P.M.G. is partially supported by the National Institute of General Medical Sciences of the National Institutes of Health under Award Number 5U54GM115428. The content is solely the authors' responsibility and does not necessarily represent the official views of the National Institutes of Health.


Objective This study aimed to identify the clinical and growth parameters associated with retinopathy of prematurity (ROP) in infants with necrotizing enterocolitis (NEC) and spontaneous ileal perforation (SIP).

Study Design We conducted a retrospective cohort study that compared clinical data before and after NEC/SIP onset in neonates, categorizing by any ROP and severe ROP (type 1/2) status.

Results The analysis included 109 infants with surgical NEC/SIP. Sixty infants (60/109, 55%) were diagnosed with any ROP, 32/109 (29.3%) infants (22% type 1 and 7.3% type 2) with severe ROP. On univariate analysis, those with severe ROP (32/109, 39.5%) were of lower median gestational age (GA, 23.8 weeks [23.4, 24.6] vs. 27.3 [26.3, 29.0], p < 0.001), lower median birth weight (625 g [512, 710] vs. 935 [700, 1,180], p < 0.001) and experienced higher exposure to clinical chorioamnionitis (22.6 vs. 2.13%, p < 0.006), and later median onset of ROP diagnosis (63.0 days [47.0, 77.2] vs. 29.0 [19.0, 41.0], p < 0.001), received Penrose drain placement more commonly (19 [59.4%] vs. 16 [34.0%], p = 0.04), retained less residual small bowel (70.0 cm [63.1, 90.8] vs. 90.8 [72.0, 101], p = 0.007) following surgery, were exposed to higher FiO2 7 days after birth (p = 0.001), received ventilation longer and exposed to higher FiO2 at 2 weeks (p < 0.05) following NEC and developed acute kidney injury (AKI) more often (25 [86.2%] vs. 20 [46.5%], p = 0.002) than those without ROP. Those with severe ROP had lower length, weight for length, and head circumference z scores. In an adjusted Firth's logistic regression, GA (adjusted odds ratio [aOR] = 0.51, 95% confidence interval [CI]: [0.35, 0.76]) and diagnosis at later age (aOR = 1.08, 95% CI: [1.03, 1.13]) was shown to be significantly associated with any ROP.

Conclusion Infants who develop severe ROP following surgical NEC/SIP are likely to be younger, smaller, have been exposed to more O2, develop AKI, and grow poorly compared with those did not develop severe ROP.

Key Points

  • Thirty percent of infants with NEC/SIP had severe ROP.

  • Those with severe ROP had poor growth parameters before and after NEC/SIP.

  • Risk factors based ROP prevention strategies are needed to have improved ophthalmic outcomes.

Authors' Contributions

P.M.G. designed the study; P.M.G., R.A.R., A.C.M., D.Z., A.S., N.M., J.S., P.P.G., and W.B.H. collected; M.A.Y.A. analyzed the data; and P.M.G., M.A.Y.A., J.S., W.B.H., and P.P.G. wrote the manuscript. All the authors contributed and approved the manuscript.

Publication History

Received: 14 July 2023

Accepted: 27 March 2024

Accepted Manuscript online:
02 April 2024

Article published online:
26 April 2024

© 2024. Thieme. All rights reserved.

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