ABSTRACT. Chronic hypoxemia adversely affects the retinopathy observed in kittens after a hyperoxic exposure (80% oxygen) in the 1st wk of life. To test the converse hypothesis, 55 kittens were randomly assigned to recover in room air (21%) or 28% inspired oxygen after a 65-h hyperoxic exposure. At 4 wk of age, the retinopathy was found to be less severe in the 28% recovered kittens, severity score 3.0 f 3.3 (mean -+ SD), than in the room air recovered animals, severity score 5.7 f 3.3, p < 0.01. This finding suggests that the clinical practice of restricted oxygenation in premature infants warrants reevaluation. (Pediatr Res 24: 106-109, 1988) Abbreviation ROP, retinopathy of prematurity ROP has been linked with supplemental oxygen administration since the 1950s when it was determined that the prolonged (more than 4 wk) use of more than 50% inspired oxygen in human premature infants without regard to cyanosis caused a 10-fold increase in severe ROP (1). Animal models of this disorder further reinforced the association with oxygen because a similar retinopathy can be produced in kittens, puppies, mice, and some other mammals by exposing them to high inspired oxygen during the 1st wk of life (2-4). This oxygen-induced retinopathy, however, does not progress to full retinal detachment and blindness, as ROP does in some infants. However, major clinical and research efforts have been aimed at preventing vision loss in infants through ever tightening control of oxygen administration (5, 6). Despite this, the disorder remains a significant problem in the 1980s, even with the most stringent oxygen monitoring efforts (7).While immaturity of the retinal vasculature at the time of birth is clearly the dominant determinant of risk for ROP, case control studies have found that the degree of illness and number of complications after delivery significantly affect the risk of severe disease after adjusting for the infant's level of immaturity (8-12). The observation that among the most premature infants, Received December 15, 1987; accepted March 15, 1988 the sickest and most unstable are at greater risk for vision loss than those whose clinical course goes smoothly led to the investigation of variable oxygenation after a retinal vascular injury. The sickest infants have more unstable oxygenation status, and on average lower arterial oxygen levels than stable infants (10). Therefore the effects of chronic hypoxia and extremely variable oxygenation were studied in the kitten model of oxygen-induced retinopathy. In this model, an initial injury to the retinal vasculature was caused by exposing the kittens to 80% oxygen for 65 h followed by a 3-wk recovery period. Quite clearly, hypoxia during the recovery period adversely affected the retinopathy (1 3), but surprisingly, a variable oxygenation status appeared to reduce its severity (14). In reporting the results of that study, we speculated that the wide but rapid (18 min) swings of oxygen from 8 to 43% where experienced by the retina as a single average effect. By integrating ...