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The objective of this study is to investigate the relationship between glycemic status and severe retinopathy of prematurity (ROP).This is a retrospective cohort study of 114 infants <1000 g admitted to a level IV neonatal intensive care unit within 48 h of life. A cumulative, time-weighted glucose level (TWGL) derived from plotting glucose values over time was included in logistic regression analysis to identify predictors for severe ROP.Infants had 26.6±2 weeks gestational age and had a birth weight of 782±136 g. TWGL during first 10 and 30 days of life were greater in the severe ROP group (P<0.01). Unlike single events of glucose levels ≥150 mg dl-1, 10 days TWGL ≥100 mg dl-1 (odds ratio (OR) 5.2, P<0.02) and 30 days TWGL ≥118 mg dl-1 (OR 5.7, P<0.02) were predictors for severe ROP (univariate). Multivariate regression confirmed 30 days TWGL ≥118 mg dl-1 (OR 9.4 to 10) and gram-positive sepsis (OR 4.1 to 5) as predictors for severe ROP (P<0.05).High overall glycemic status is associated with the development of severe ROP.