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The nucleated red blood cell count at birth, the volume of red cell transfusions received, and the risk of developing retinopathy of prematurity

Journal of Perinatology volume 45, pages 1809–1815 (2025)Cite this article

Subjects

Abstract

Background

Previous studies described an association between the NRBC count at birth and risk of developing retinopathy of prematurity (ROP). Other studies correlated red blood cell (RBC) transfusions with ROP. We are aware of no studies that examined both NRBC count and RBC transfusions, in the same cohort, on ROP risk.

Study design

We retrospectively analyzed all infants in the Intermountain Health NICUs during the past four years who were born <32 weeks had a NRBC count at birth and had ROP examinations.

Results

Records of 386 infants demonstrated that both factors are associated with ROP. For every 1000/µL increase in NRBC, severe (grade ≥3) ROP increased by 6.8% (95% CI, 3.0–10.0%). RBC transfusions were associated with ROP incidence and severity (p = 0.001). However, neither factor alone was either necessary or sufficient for ROP.

Conclusion

The NRBC count at birth and the volume of RBC transfusions both influence ROP severity.

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Data availability

Inquiries regarding data access can be addressed to the corresponding author.

Code availability

Computer code used for statistical analysis is available upon written request to the corresponding author.

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Authors and Affiliations

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

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

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

    Timothy M. Bahr & Robert D. Christensen

  3. Department of Mathematics, Brigham Young University, Provo, UT, USA

    Samuel D. Esplin

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

    M. Elizabeth Hartnett

  5. Department of Pathology and Transfusion Medicine, Intermountain Health, Murray, UT, USA

    Sarah J. Ilstrup

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  1. Bailey Zeiler
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  2. Timothy M. Bahr
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  3. Samuel D. Esplin
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Contributions

Conceptualization, TMB, KD, RKO, RDC, Methodology, TMB, KD, RDC, Original Draft Preparation, RDC, Review and Editing, BZ, TMB, KD, MEH, SJI, RKO, RDC.

Corresponding author

Correspondence to Timothy M. Bahr.

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Competing interests

The authors declare no competing interests.

Ethics approval

The protocol for conducting this retrospective, deidentified, records review was approved by the Intermountain Health Institutional Review Board with a waiver of informed consent (IRB # 1051715). All methods were performed in accordance with United States Department of Health and Human Services regulations, including the Health Insurance Portability and Accountability Act (HIPAA) and the Federal Policy for the Protection of Human Subjects (Common Rule, 45 CFR 46).

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Zeiler, B., Bahr, T.M., Esplin, S.D. et al. The nucleated red blood cell count at birth, the volume of red cell transfusions received, and the risk of developing retinopathy of prematurity. J Perinatol 45, 1809–1815 (2025). https://doi.org/10.1038/s41372-025-02519-3

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