Reduced oxygen protocol decreases the incidence of threshold retinopathy of prematurity in infants of <33 weeks gestation

Abstract

A significant decrease in the rate of threshold ROP in infants of <33 weeks gestation was observed after implementation of the new clinical O(2) management practice.

Effect of decreasing target oxygen saturation on retinopathy of prematurity

“…[10][11][12][13][14][15][16][17][18] The authors of multiple reports [19][20][21][22][23][24][25] have demonstrated a marked increase in both the incidence and severity of ROP in humans and related neovascular retinopathies in other mammals after oxygen supplementation. Aggressive supplemental oxygenation of premature infants also strains the health care system both in the extended duration of therapy as well as more intensive outpatient care not necessary for infants with a more moderate oxygen saturation target.…”

“…Aggressive supplemental oxygenation of premature infants also strains the health care system both in the extended duration of therapy as well as more intensive outpatient care not necessary for infants with a more moderate oxygen saturation target. 10,26 However, although lower levels of oxygen supplementation do result in a lower incidence of ROP and related neovascular retinopathies in other mammals, [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] overaggressive limitation of oxygen to less physiologic levels may increase morbidity and mortality, 18,27,28 although a more physiologic reduction could be less detrimental. 29 In this study we compared the incidence and severity of ROP during the 2 years immediately before and the 2 years immediately after the initiation of a new oxygen protocol targeting oxygen saturations at 85% to 93% for all inborn premature infants at a level III neonatal intensive care unit (NICU).…”

In Search of the Optimal Oxygen Saturation for Extremely Low Birth Weight Infants: A Systematic Review and Meta-Analysis

“…Three randomized trials [16,22,23] and 5 observational studies [12,20,24,25,28] including 4,612 patients investigated the association between SpO 2 and BPD ( table 2 ). There was a significantly reduced incidence of BPD or lung problems in the low versus high saturation groups.…”

“…One randomized trial [16] and 7 observational studies [12,20,[24][25][26][27][28] including 3,811 patients investigated the association between SpO 2 and the incidence of severe ROP ( table 2 ). There was a significantly reduced incidence of severe ROP in the low SpO 2 group with a summary RR of 0.42 (95% CI 0.34-0.51) ( figure 1 ).…”

“…Noori et al [20] studied ROP and BPD in extremely low birth weight infants in 2 hospitals in the Los Angeles region before and after a reduction of SpO 2 Tokuhiro et al [28] performed at retrospective analyses in babies ! 33 weeks of gestational age from a single hospital in Japan.…”