Title : Aggressive retinopathy of prematurity and intraventricular hemorrhage in Kazakhstan the role of birth weight and gestational age
Abstract:
Aggressive retinopathy of prematurity (A-ROP) is characterized as the most severe form of the disease, with a fulminant course and the development of volcano-shaped retinal detachment, most commonly occurring in extremely preterm infants. Among disabling conditions in preterm neonates, brain injury occupies a particular place, with severe forms of intraventricular hemorrhage (IVH) being especially frequent. IVH results from impaired vascularization of the brain in preterm infants and is largely dependent on gestational age. The presence of IVH further complicates the clinical course of A-ROP, increasing the likelihood of retinal detachment leading to irreversible blindness, with the risk reaching up to 50%.
Objective: To study the incidence of intraventricular hemorrhage in neonates with aggressive retinopathy of prematurity in Kazakhstan.
Materials and Methods: A retrospective analysis included 3,048 preterm infants (birth weight <2,000 g; gestational age <34 weeks) from neonatal centers in Kazakhstan. Retinopathy of prematurity (ROP) was identified in 1,969 cases (64.6%). Infants were categorized into extremely low (ELBW), very low (VLBW), and low birth weight (LBW) groups. Each group was evaluated for intraventricular hemorrhage (IVH), gestational age, and birth weight. IVH was confirmed by neurosonography, while ROP was diagnosed using binocular indirect ophthalmoscopy and digital fundus imaging. Statistical analysis was performed in Microsoft Excel (version 16.101.1, 2025) using descriptive statistics, and graphs were created with GraphPad Prism (version 10, 2023).
Results: Aggressive ROP (A-ROP) was diagnosed in 122 infants, with IVH in 81 (66.4%). In ELBW (n=48, 59.3%), IVH was grade I – 16.7%, II – 31.3%, III – 47.9%, IV – 4.2%. Mean birth weight 875 ± 120 g, gestational age 28.8 ± 1.8 weeks. In VLBW (n=28, 34.6%), IVH was grade I – 39.3%, II – 35.7%, III – 25.0%. Mean birth weight 1368 ± 122 g, gestational age 30.3 ± 1.4 weeks. In LBW (n=5, 6.1%), IVH was grade II – 80%, III – 20%. Mean birth weight 2062 ± 197 g, gestational age 32.8 ± 1.2 weeks.
Conclusion: The findings confirm the importance of a comprehensive approach to early diagnosis of aggressive retinopathy of prematurity in Kazakhstan, especially in infants with extremely low birth weight. Associations between A-ROP incidence, birth weight, and intraventricular hemorrhage severity allow prediction of disease progression and adaptation of therapeutic strategies.
