The purpose of this study was to assess postnatal weight gain as a tool to stratify infants at risk of developing severe retinopathy of prematurity (ROP) in a US Midwestern neonatal ICU cohort. The authors sought to develop a simpler prognostic screening model using daily postnatal weight gain, birth weight and gestational age that maintains sensitivity but improves specificity in detecting severe ROP in comparison to current screening guidelines. The study included 191 infants with required measurements. Seventeen developed type I ROP requiring treatment; 174 had type 2, mild or no ROP and no treatment was needed. Type 1 had a lower mean birth weight and lower weight at 36 weeks corrected gestational age. Calculated weight gain cut-off rate was 23g/day as a protective factor against developing type 1, for 100% sensitivity; specificity was 62%. The authors specify that growth rate is not to be used as an isolated risk factor but as an adjunct to screening guidelines. If 23g/day cut-off was implemented, their screening burden would have decreased by 58% whilst maintaining 100% sensitivity (capturing all infants with high grade ROP).