Pulse oximetry, severe retinopathy, and outcome at one year in babies of less than 28 weeks gestation

Abstract

Aim-To determine whether diVering policies with regard to the control of oxygen saturation have any impact on the number of babies who develop retinopathy of prematurity and the number surviving with or without signs of cerebral palsy at one year. Methods-An examination of the case notes of all the 295 babies who survived infancy after delivery before 28 weeks gestation in the north of England in 1990-1994. Results-Babies given enough supplemental oxygen to maintain an oxygen saturation of 88-98%, as measured by pulse oximetry, for at least the first 8 weeks of life developed retinopathy of prematurity severe enough to be treated with cryotherapy four times as often as babies only given enough oxygen to maintain an oxygen saturation of 70-90% (27.2% v 6.2%). Surviving babies were also ventilated longer (31.4 v 13.9 days), more likely to be in oxygen at a postmenstrual age of 36 weeks (46% v 18 %), and more likely to have a weight below the third centile at discharge (45% v 17%). There was no diVerence in the proportion who survived infancy (53% v 52%) or who later developed cerebral palsy (17% v 15%). The lowest incidence of retinopathy in the study was associated with a policy that made little use of arterial lines. Conclusions-Attempts to keep oxygen saturation at a normal "physiological" level may do more harm than good in babies of less than 28 weeks gestation. (Arch Dis Child Fetal Neonatal Ed 2001;84:F106-F110)

Clinical practices in neonatal oxygenation: where have we failed? What can we do?

“…40 At the time of these prospective studies, there were surveys or cohort studies that also supported an association with less ROP in different centers utilizing different SpO2 targets. [41][42][43] Recently, several studies [44][45][46] have confirmed our findings. Wright et al 44 concluded that SPO 2 between 83 and 93% and avoiding oxygen fluctuations prevent the early vaso-obliterative phase and subsequent severe ROP.…”

Vascular endothelial growth factor in eye disease

“…Although the precise oxygen saturations to avoid remain unknown, avoiding hyperoxia, and particularly avoiding swings between hyperoxia and hypoxia, in the first few weeks of life has been shown to decrease the severity of ROP Askie and Henderson-Smart, 2000;Tin et al, 2001;Chow et al, 2003;Anderson et al, 2004;York et al, 2004). The relationship between hyperoxia and subsequent neovascularization appears more complex than suggested previously.…”

Incidence of severe retinopathy of prematurity before and after a modest reduction in target oxygen saturation levels

“…Implementation of these guidelines appears to have reduced the incidence of ROP. [5][6] At the beginning of 2004, our neonatal intensive care unit instituted new oxygen saturation guidelines with a targeted range of 90-96% for infants ≤ 30 weeks gestational age at birth. Before then, oxygen saturation levels were generally kept in the upper 90's.…”