Background: Retinopathy of Prematurity (ROP) is a preventable cause of childhood blindness. The global incidence of ROP is increasing, though the contributing factors differ between developed and developing countries. 
Objectives: This study aimed to determine the prevalence of ROP and to identify associated risk factors among preterm neonates admitted to the neonatal intensive care units of three hospitals within the Baghdad Medical City complex.
Methods: A prospective study was conducted from January 1, 2019, to January 1, 2020, in the neonatal intensive care units (NICUs) of Medical City Hospitals in Baghdad: Children Welfare Teaching Hospital, Baghdad Teaching Hospital, and a Private Nursing Home. Inclusion criteria were gestational age (GA) <34 weeks and/or birth weight (BW) <2000g; unstable infants exceeding these criteria were also included. All eligible infants underwent retinal examinations by an ophthalmologist at 4-6 weeks of age using RetCam imaging.
Results: Eighty-nine infants were included. The mean GA was 31.1±1.9 weeks and the mean BW was 1333.2±254.7 grams. The incidence of ROP was 20 (22.5%). A highly significant association was found between ROP and lower GA, lower BW, blood transfusion, intraventricular hemorrhage, mechanical ventilation, necrotizing enterocolitis, and sepsis. No significant association was found with gender or multiple pregnancy.
Conclusions: The prevalence of ROP was significant. Key risk factors were gestational age less than 32 weeks of gestation, birthweight less than 1250g, and clinical complications. The findings underscore the critical need for stringent ROP screening protocols and optimized neonatal care strategies, including minimizing transfusions, enhancing infection control, and improving respiratory management, to reduce ROP-related morbidity.