Exposure to unblended oxygen may require earlier first retinopathy of prematurity screening examination and modification of existing screening guidelines in Sub-Saharan Africa.

The purpose of this case series is to consider whether preterm infants having gestational age (GA) ≥32 weeks and birth weight (BW) ≥1500 g exposed to unblended oxygen should be screened earlier than the current guidelines adopted from Kenya for the third epidemic of retinopathy of prematurity (ROP). Cases of such infants with severe, treatment-requiring ROP at St Francis Hospital Nsambya, Kampala, Uganda, were reviewed for severe ROP requiring treatment prior to 30 days of life. Since 2022, 3 infants required treatment prior to 30 days of life. All infants received unblended oxygen for 5-10 days after birth and were on room air at the time of treatment. GA ranged from 32 to 34 weeks, and all had BW >1500 g. All infants had chronological age of 2 weeks at treatment. Preterm babies who are born at GA ≥32 weeks and exposed to unblended oxygen may be at risk of developing severe, treatment-requiring ROP earlier than the adopted guidelines from other countries have suggested.