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Purpose: to evaluate the Retinopathy of prematurity prevalence and screening outcome in a tertiary hospital in Cairo, Egypt. Also, to assess the risk factors for its development and to suggest modifications to the international guidelines for screening for Retinopathy of prematurity to fit the Egyptian population. Methods: A prospective observational study was carried out in Neonatal Intensive Care Unit (NICU) in Ain Shams University Hospital. In this study 159 premature infants born in the period between 1 September 2018 to 1 September 2021 were screened for Retinopathy of Prematurity (ROP). Screening was based on the most inclusive criteria reported to date. All premature infants with gestational age (GA) of ≤34 weeks or birth weight (BW) of ≤2000 grams were included. Infants were also included if GA>34 weeks or BW>2000 grams, but multiple co-morbidities existed. The prevalence of retinopathy of prematurity and plus disease and their correlation with risk factors of interest were studied. Results: The gestational age of the included infants ranged from 27 to 36 weeks, with a mean (SD) of 31.87 (‡ 1.81) weeks. Infants had birth weight ranging from 640 to 3900 grams, with a mean (SD) of 1784.71 (± 560.30) grams. The prevalence of ROP changes more than stage 0 in the screened infants was 25.8% (41 infants) with 7.3% of cases (11 infants) showing plus disease and 6.3% of cases (10 infants) showing severe changes that needed treatment. Of those, 2 cases (20%) fell outside the British Guideline's criteria for Screening. there was a highly significant (p<0.0001) correlation between appearance of Retinopathy of prematurity changes more than stage 0 and low gestational age, low birth weight of the screened infants, receiving mechanical ventilation, respiratory distress syndrome stage, presence of Necrotizing enterocolitis, Intraventricular haemorrhage and blood transfusion. On the other hand, no significant correlation was found between appearance of Retinopathy of prematurity changes more than stage 0 and gender (p=0.911), presence of PDA (p=0.187), or sepsis (p=0.998). Conclusion: Retinopathy of prematurity is a significant problem in the premature infants in Cairo, Egypt. Extremely premature infants with lower birth weight are more prone to develop this disease. However, cases with higher gestational age and birth weight than mentioned in the British guidelines screening criteria especially with multiple comorbidities showed severe Retinopathy of prematurity changes that needed intervention, which implies the need to develop a screening guideline for the Egyptian population. [ABSTRACT FROM AUTHOR]