An Unusual Manifestation: Retinopathy Of Prematurity in Late Preterm Infants A Case Series

Abstract

Background: Retinopathy of Prematurity (ROP) is a significant cause of preventable childhood blindness. ROP has been strongly associated with extreme prematurity and prolonged oxygen therapy. Recent reports indicate that ROP can occur even in late preterm infants without extended oxygen exposure, particularly when other perinatal risk factors are present. Early detection and timely intervention are crucial to prevent progression to severe stages that can result in permanent vision loss.

Case presentation: We present two neonates with retinopathy of prematurity.

Case 1: A male infant was born at 34 weeks of gestation via spontaneous vaginal delivery, with a birth weight of 1600 grams. Continuous positive airway pressure (CPAP) was initiated after birth due to dyspnea and grunting. The mother had a risk of infection with the leukocyte count of 17,000/mm³. Suspected intrauterine growth restriction (IUGR) was diagnosed. On the second week of life, a routine ophthalmologic screening revealed stage 2 retinopathy of prematurity in the posterior Zone II, bilaterally, without plus disease. The patient is scheduled for a repeat ROP examination in 1 week.

Case 2: A male infant was delivered at 34 weeks of gestation via cesarean section, with a birth weight of 1650 grams. The mother, 32 years old, G3P1102, had preeclampsia, anemia, hypoalbuminemia and a fetus with IUGR. CPAP was initiated due to dyspnea and grunting. On second weeks of life, ophthalmologic screening revealed stage 2 retinopathy of prematurity in the posterior Zone II, bilaterally, without plus disease. The patient is scheduled for a repeat ROP examination in 1 week.

Conclusion: ROP may develop in late preterm infants despite minimal postnatal oxygen exposure when prenatal risk factors such as intrauterine growth restriction and maternal comorbidities are present. Screening protocols based solely on gestational age and oxygen history may therefore fail to identify infants who remain at risk; a more individualized, risk-based approach to ROP screening is warranted.