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Involving neonatal hematology and transfusion medicine in global efforts to eliminate severe retinopathy of prematurity

Journal of Perinatology volume 45, pages 1839–1847 (2025)Cite this article

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Abstract

Retinopathy of Prematurity (ROP) remains a worldwide problem. A more complete understanding of the pathogenesis might inform progress toward its elimination. ROP pathogenesis is undeniably complex, including preterm birth and oxygen exposure, but many other factors are implicated as well. In this Perspective, we focus on two pathogenic factors that are within the domain of neonatal hematology and transfusion medicine. Specifically, we address evidence that ROP pathogenesis can involve: 1) an elevated nucleated red blood cell (NRBC) count at preterm birth, as evidence of chronic hypoxia in utero, which should be recognized as a biomarker of elevated risk for developing ROP; and 2) transfusions of adult donor red blood cells (RBC) result in a dose-dependent elevation in adult hemoglobin (HbA), which can deliver and release excessive oxygen to the developing retina. Early studies indicate that eliminating adult donor RBC transfusions for vulnerable preterm infants might reduce or eliminate ROP.

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Fig. 1: Percentage of fetal hemoglobin (HbF) in the blood and ROP status.
Fig. 2: Four recommendations for neonatologists based on evidence in this perspective.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA

    Robert D. Christensen, Timothy M. Bahr & Robin K. Ohls

  2. Neonatology Research and Clinical Program, Intermountain Health, Murray, UT, USA

    Robert D. Christensen & Timothy M. Bahr

  3. Transfusion Medicine, Intermountain Health, Murray, UT, USA

    Sarah J. Ilstrup

  4. Department of Ophthalmology, Byers Eye Institute, Stanford University, Palo Alto, CA, USA

    M. Elizabeth Hartnett

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  1. Robert D. Christensen
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  2. Timothy M. Bahr
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  3. Sarah J. Ilstrup
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  4. M. Elizabeth Hartnett
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  5. Robin K. Ohls
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Conceptualization, RDC, TB, SJI, MEH, and RKO. Methodology, RDC, TM, SJI, MEH, and RKO. Original Draft Preparation, RDC. Review and Editing, RDC, TM, SJI, MEH, and RKO.

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Correspondence to Robert D. Christensen.

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Christensen, R.D., Bahr, T.M., Ilstrup, S.J. et al. Involving neonatal hematology and transfusion medicine in global efforts to eliminate severe retinopathy of prematurity. J Perinatol 45, 1839–1847 (2025). https://doi.org/10.1038/s41372-025-02368-0

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