Wide-field Digital Retinal Photography in 10,330 Newborns: Prevalence, Risk Factors and Clinical Implications in a Large Chinese Cohort

Objective To characterize the prevalence and spectrum of fundus abnormalities in a large newborn cohort and to evaluate the association of these abnormalities with perinatal immaturity, a novel composite neonatal morbidity index, and a composite maternal high-risk index. Design: Retrospective, single-center cohort study. Participants: A total of 10,330 consecutive newborns who underwent universal wide-field digital retinal photography (WFDRP) screening within 72 hours of birth. Methods Two novel aggregated indices—the Neonatal Risk Count (summing complications across four domains: baseline risk, respiratory support, feeding/gastrointestinal issues, and hematologic/metabolic issues) and the Maternal High-Risk Count (summing peripartum risk factors)—were constructed. Fundus findings were classified as normal or abnormal. Univariable and multivariable logistic regression were used to assess associations, with multicollinearity assessed by variance inflation factors (VIF). Main Outcome Measures: Prevalence of any fundus abnormality; adjusted odds ratios (OR) for the association between abnormal fundus status and key predictors including birth weight, gestational age, Neonatal Risk Count, and Maternal High-Risk Count. Results Fundus abnormalities were detected in 3,079 infants (29.8%). Retinal hemorrhage was the most common finding (60.1% of abnormalities). In the final multivariable model, a higher Neonatal Risk Count (OR 1.42 per additional risk, 95% CI 1.23–1.63, p < 0.001), lower birth weight (OR 1.00 per gram, p < 0.001), and lower gestational age (OR 0.96, 95% CI 0.93–1.00, p = 0.05) were independent predictors of abnormal findings. The Maternal High-Risk Count showed a significant inverse association (OR 0.80, 95% CI 0.76–0.84, p < 0.001). Other neonatal clinical domain counts and sex were not significant. All VIFs were < 2. Conclusions In this large cohort, nearly one-third of newborns had detectable fundus abnormalities on WFDRP. Cumulative neonatal morbidity burden and perinatal immaturity were significant risk factors, while a higher aggregated maternal risk score was associated with lower odds of abnormality. These findings support the utility of WFDRP in universal newborn screening and highlight the importance of neonatal systemic health in ocular outcomes.