A new study has identified a significant link between low hemoglobin levels and the development of retinopathy of prematurity (ROP) in preterm infants. The study, conducted at a neonatal intensive care unit in Odisha, India, analyzed 148 neonates born before 34 weeks of gestation, finding that 29% developed some stage of ROP.

A multivariate regression model for independent risk factors found that birth weight, hemoglobin (Hb) level, presence of respiratory distress syndrome, and need for packed red blood cell transfusion were independently associated with ROP development. Hemoglobin levels within the first 48 hours of life were particularly telling, as infants with Hb levels between 10.5 and 17.3 g/dL were found to be at a significantly higher risk of ROP compared to those with Hb levels >17.3 g/dL.

“The study has major implications for middle-income countries, where the third epidemic of ROP has emerged,” the study authors wrote in Cureus. “It could help the clinician triage the preterm infant based on the early Hb level, and neonates with an early lower Hb level are prioritized for ROP screening.”