Does First Blood Draw Matter in Retinopathy of Prematurity: A Comparative Analysis of Inflammation and Hypoxia-Related Parameters.

Aim: To compare the inflammation and hypoxia-related parameters in the first 24-hour complete blood count (CBC) and arterial blood gas (ABG) analysis among infants diagnosed with retinopathy of prematurity (ROP), those requiring treatment for ROP, and those without any stage of ROP. Methods: Three hundred and thirty infants screened for ROP with CBC, ABG analysis, and albumin results in the first 24 hours after delivery were included. In addition to individual cell counts on CBC and hypoxia indicators in ABG analysis, systemic immuno-inflammatory index (SII), systemic inflammatory response index (SIRI), pan-immune inflammation value (PIV), and hemoglobin, albumin, lymphocyte, and platelet (HALP) values were calculated and compared between the study groups. Results: No significant differences were observed in SII, SIRI, PIV, and HALP scores among any groups, whether for ROP diagnosis or treatment requirement. Multivariate analysis showed significant differences in red blood cell count (RBC) (p=0.001), hemoglobin (HGB) (p=0.001), mean corpuscular volume (p<0.001), and mean corpuscular hemoglobin concentration (p<0.001) between infants with and without ROP. RBC (p=0.001) and HGB (p=0.002) also significantly differed between neonates needing treatment and those not, but were not independent predictors of treatment necessity in the multivariate analysis. No significant differences in ABG parameters were found among the groups for either ROP diagnosis or treatment need. Discussion: This study contributes to the literature by being the first to evaluate emerging inflammatory indices such as SIRI, PIV, and HALP in the context of ROP, demonstrating that these parameters from the initial blood draw do not provide predictive value. While erythrocyte-related markers showed some associations, they were not independent predictors of treatment need, highlighting the importance of cautious interpretation of early hematologic findings. These results underscore that the very first blood sample may reflect transitional neonatal physiology more than disease-specific mechanisms, and they encourage future studies to explore longitudinal sampling for more reliable biomarkers. Conclusion: The novel inflammatory markers, SII, SIRI, PIV, and HALP score, obtained from blood tests within the first 24 hours of neonatal life, do not appear to be predictive of ROP development or the need for treatment.