Introduction: To study the incidence and to identify neonatal risk factors which could influence the development and progression of ROP. Materials and Methods: A hospital-based, prospective observational study was conducted at neonatal intensive care unit and ophthalmology unit of Amrita Institute of Medical Sciences and Research Centre during period of May 2008 to December 2009 in which babies <32 weeks and <1500 gms were included. Preterm infants were screened by pediatric ophthalmologist using indirect opthalmoscopy and retinopathy was graded following the International Classification of ROP. Neonatal risk factors for ROP were assessed by univariate and multiple logistic regression analysis. Results: Seventy four infants entered in this case study. Incidence of ROP was 35.1%. In univariate model lower birth weight, lower gestational age , Hypotension requiring ionotropic support, hemodynamically significant patent ductus arteriosus requiring treatment , Anemia , septicemia ,Intraventricular hemorrhage ,apnea, blood transfusion, RDS, oxygen, was associated with a higher incidence of retinopathy of prematurity. In multiple regression gestational age and duration of oxygen found significant. Conclusion: Lower gestatinal age, lower birth weight, sepsis, apnea, blood transfusion, duration of oxygen are associated with a greater incidence retinopathy of prematurity. These factors must be prevented and more care for early detection of retinopathy should be conducted.