Abstract
Retinopathy of prematurity (ROP) is a leading cause of preventable blindness in preterm infants, with a disproportionate burden in low- and middle-income countries. Screening criteria from high-income settings may not be directly applicable in these contexts. We developed and validated two pragmatic risk-based screening models using multicenter Indonesian neonatal data: Model A (FiO₂-based) and Model B (SpO₂-based). Significant predictors included intrauterine growth restriction, oxygen exposure, exchange transfusion, and socioeconomic status. Internal validation showed moderate discrimination (AUC 0.719-0.732) with sensitivities of 77-86% and specificities of 44-58%. The bedside operational score form is presented for clinical use. External validation in 163 infants (gestational age 25-37 weeks, birth weight 600-2000 g) confirmed robust performance, with the combined rule (positive if either model was positive) achieving a sensitivity 84%, a specificity 81%, positive predictive value 76%, and negative predictive value 87%. The pre-test probability of ROP was 0.42, increasing to 0.76 after a positive screen and decreasing to 0.13 after a negative result. These findings support the use of locally validated risk-based scores as a practical complement to gestational age and birth weight criteria, optimizing ROP case finding in resource-limited settings.