High or Low Oxygen Saturation and Severe Retinopathy of Prematurity: A Meta-analysis

Abstract

CONTEXT Low oxygen saturation appears to decrease the risk of severe retinopathy of prematurity (ROP) in preterm newborns when administered during the first few weeks after birth. High oxygen saturation seems to reduce the risk at later postmenstrual ages (PMAs). However, previous clinical studies are not conclusive individually. OBJECTIVE To perform a systematic review and meta-analysis to report the association between severe ROP incidence of premature infants with high or low target oxygen saturation measured by pulse oximetry. METHODS Studies were identified through PubMed and Embase literature searches through May 2009 by using the terms “retinopathy of prematurity and oxygen” or “retinopathy of prematurity and oxygen therapy.” We selected 10 publications addressing the association between severe ROP and target oxygen saturation measured by pulse oximetry. Using a random-effects model we calculated the summary-effect estimate. We visually inspected funnel plots to examine possible publication bias. RESULTS Low oxygen saturation (70%–96%) in the first several postnatal weeks was associated with a reduced risk of severe ROP (risk ratio [RR]: 0.48 [95% confidence interval (CI): 0.31–0.75]). High oxygen saturation (94%–99%) at ≥32 weeks’ PMA was associated with a decreased risk for progression to severe ROP (RR: 0.54 [95% CI: 0.35–0.82]). CONCLUSIONS Among preterm infants with a gestational age of ≤32 weeks, early low and late high oxygen saturation were associated with a reduced risk for severe ROP. We feel that a large randomized clinical trial with long-term developmental follow-up is warranted to confirm this meta-analytic result.

Graded oxygen saturation targets and retinopathy of prematurity in extremely preterm infants

“…Their study showed that the rate and severity of ROP increased especially amongst extremely preterm infants after adopting a higher SpO 2 target (91-95%) with no concomitant reduction in mortality but the study was underpowered for this outcome (29). Based on the pathophysiology of ROP, studies were designed to address the issue of using a higher SpO 2 target at 32 wk PMA which resulted in reduced progression to severe ROP (30). We implemented graded SpO 2 targets in 2002, mimicking oxygen delivery: oxygen consumption ratios during fetal life.…”

The Effect of Oxygen Therapy on the Development of Retinopathy of Prematurity

“…Recently published studies recommend the use of supplementary oxygen in premature babies with gestation ≥32 GW during the first few weeks of life, with lower oxygen saturation (85-93%), whilst later than ≥32 GW they should have higher oxygen saturation (94-99%). This approach to treatment with oxygen is accompanied by a reduction in the risk of occurrence of severe forms of ROP (23,26).…”

Guideline for the prevention, screening and treatment of retinopathy of prematurity (ROP)

“…20 A meta-analysis of the association between SaO 2 measured by pulse oximetry and risk of severe ROP indicated a statistically significant risk reduction of 52% with low SaO 2 (70 -96%) in the first postnatal weeks and 46% with high SaO 2 (>94 -99%) at a postmenstrual age (PMA) of ≥32 weeks. 21 The analysis revealed that high SaO 2 has different effects at postnatal points that correspond roughly to the first and second phases of ROP.…”

“…In a meta-analysis of high or low oxygen saturation and severe ROP, Chen et al 21 concluded that low SaO 2 (70 -96%) in the first several postnatal weeks was associated with a reduced risk of severe ROP (RR 0.48; 95% CI 0.31 -0.75) and high SaO 2 (94 -99%) after a PMA of 32 weeks was associated with a decreased risk for progression to severe ROP (RR 0.54; 95% CI 0.35 -0.82). 21 Currently, the ongoing Neonatal Oxygen Prospective Metaanalysis (NeOProM) study is questioning whether targeting a lower oxygen range in extremely premature neonates increases or decreases the composite outcome of death or major disability in survivors by ≥4%.The results of the study will be available in 2014.…”