{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:50:04Z","timestamp":1791651004888,"version":"4.3.4"},"reference-count":0,"publisher":"S. Karger AG","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"},{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/karger.com\/pages\/terms-and-conditions"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Neonatology"],"abstract":"<jats:p>Background: Retinopathy of prematurity (ROP), the leading cause of preventable childhood blindness in preterm infants, is associated with red blood cell transfusions from adult donors. Whether this risk is driven by the resulting loss of fetal hemoglobin (HbF) remains unclear. We assessed whether postnatal HbF decline mediates the transfusion-ROP association and developed a predictive tool based on HbF kinetics to estimate individual ROP risk. Methods: We conducted a prospective cohort of infants below 32 weeks' gestation (2021\u20132026). HbF was measured at birth and on days 7, 14, and 28. A LASSO-regularized logistic model identified independent ROP predictors and generated a probability-based prediction tool. Causal mediation analysis, adjusted for gestational age, assessed whether HbF decline mediates the transfusion-ROP association. Results: Among 403 infants, ROP developed in 11.7%. Day-14 HbF decline and gestational age were retained as main predictors of ROP. Each 10-percentage-point drop in HbF by day 14 increased ROP odds by 34% (OR, 1.34; 95% CI, 1.11\u20131.63; P&lt;0.001). The model showed strong discrimination on internal validation (2000-repetition bootstrap with cross-validation: AUC 0.90; NPV 98.1%). In mediation analysis, HbF decline over the first 28 days accounted for 71.8% of the total effect of transfusion on ROP (P=0.003), suggesting HbF loss, not transfusion per se, drives this association. Conclusions: Postnatal HbF decline is an independent predictor of ROP and the dominant pathway linking transfusion to retinal injury in preterm infants, supporting further research on HbF preservation as a preventive strategy. Our HbF kinetics-based tool showed high discriminative accuracy (AUC 0.90), enabling early, individualized risk stratification.<\/jats:p>","DOI":"10.1159\/neo\/adsag022","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T11:34:04Z","timestamp":1791286444000},"source":"Crossref","is-referenced-by-count":0,"title":["Fetal hemoglobin decline predicts retinopathy of prematurity and mediates the effect of red blood cell transfusion"],"prefix":"10.1159","author":[{"given":"Laura","family":"Torrej\u00f3n-Rodr\u00edguez","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Cayuela-Hern\u00e1ndez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alejandro","family":"Pinilla-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nerea","family":"Valles-Murcia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abel","family":"Albiach-Delgado","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Kuligowski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Cernada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Brugada-Montaner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabel","family":"Torres-Cuevas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marta","family":"Aguar Carrascosa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"127","published-online":{"date-parts":[[2026,10,10]]},"container-title":["Neonatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/karger.com\/article-pdf\/doi\/10.1159\/neo\/adsag022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:01:46Z","timestamp":1791648106000},"score":1,"resource":{"primary":{"URL":"https:\/\/karger.com\/article\/doi\/10.1159\/neo\/adsag022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,10]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1159\/neo\/adsag022","archive":["Portico"],"relation":{"is-supplemented-by":[{"id-type":"doi","id":"10.6084\/m9.figshare.34232187","asserted-by":"subject"}]},"ISSN":["1661-7800","1661-7819"],"issn-type":[{"value":"1661-7800","type":"print"},{"value":"1661-7819","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,10]]}}}