Background: Advances in neonatal care increased survival rates of preterm neonates, with a consequent increase in the number of infants affected by retinopathy of prematurity (ROP). Objectives: Type of nutrition and low weight gain during the first 6 weeks of life in preterm infants might be an important contributing factor associated with developing the ROP. Aim: Our study aimed to evaluate the effect of type of nutrition and low weight gain on the incidence of ROP in premature infants Patients and methods this prospective; one-year cohort study was conducted in the Neonatology Department, in Collaborate with the Ophthalmology Department in the Faculty of Medicine, Zagazig University. The study included 72 preterm neonates, the included patients were subjected to careful history taking, clinical examination daily body weight, weekly length, and head circumference were measured, nutrition data were collected, and Fundus examination was done with binocular indirect ophthalmoscopy and digital color fundus images. Results: Out of the 72 screened preterm babies, (41.7%) cases had ROP, among whom (35.7%) had stage I, (24.5%) had stage II (39.8%) had aggressive ROP stage III zone II , 60% had threshold and (33.3%) with plus disease. There is statistically significant relations between ROP development and weight loss (p<0.001), (OR, 4.5; 95% CI, 0.37- 54.15), Total parenteral nutrition (TPN) (p=0.008), (OR ,2.05; 95% CI, 0.8-4.7), breast feeding(p<0.001), (OR, 0.06; 95% CI, 0.01-0.31), prolonged duration of admission (p<0.005), Prolonged duration of oxygen therapy (p<0.002), Sepsis (p<0.001), Anemia (p<0.001), Respiratory distress syndrome (RDs) (p<0.001), Pneumonia (p<0.013), Bronchopulmonary dyspepsia (BPD) (p<0.005), Intra ventricular hemorrhage (IVH) (p<0.005). As all of these factors, were increasing the incidence of disease. Conclusion: We found that the incidence of ROP in our cohort study indicates that improving nutritional intake and early initiation of breast milk feeding reduced the risk of its development. Where small for gestation (SFG), relative postnatal weight gain or weight losses in the first sex weeks of are risk factors for threshold ROP. We also found that RD, sepsis, BPD, IVH, anemia, frequent blood transfusions, oxygen therapy and their duration are the most important risk factors for developing ROP in preterm infants.