A Change in Oxygen Supplementation Can Decrease the Incidence of Retinopathy of Prematurity (original) (raw)
Related papers
Use of a Supplemental Oxygen Protocol to Suppress Progression of Retinopathy of Prematurity
Investigative Opthalmology & Visual Science, 2017
PURPOSE. To compare progression of retinopathy of prematurity (ROP) before and after institution of an oxygen therapy protocol to inhibit active proliferation and progression of ROP in premature infants. METHODS. A retrospective cohort study was performed of premature infants undergoing ROP screening before (cohort A) and after (cohort B) implementation of an oxygen therapy protocol to inhibit further progression for those with stage 2 ROP or worse. Statistical analysis with v 2 , Fisher's exact test, or Wilcoxon rank sum test was performed; and logistic regression models were created to determine the odds ratio of cohort B developing ROP progression beyond stage 2, compared to cohort A, adjusting for other risk factors for ROP. RESULTS. In cohort A, without oxygen therapy protocol (2002-2007), 44% (54/122) of infants progressed beyond stage 2, compared to 23% (24/103) of infants after protocol implementation (cohort B, 2008-2012) (P ¼ 0.001). No significant differences between cohort A and B were found for gestational age, birth weight, survival, sepsis, bronchopulmonary dysplasia, oxygen at discharge, or need for diuretics. Infants with stage 2 ROP in cohort B, with oxygen therapy protocol, had significantly decreased risk of ROP beyond stage 2 (odds ratio 0.37, 95% confidence interval 0.20-0.67; P ¼ 0.0013), compared to cohort A, correcting for differences in birth weight and necrotizing enterocolitis. CONCLUSIONS. Progression from stage 2 to stage 3 ROP in premature infants was significantly decreased after implementation of an oxygen therapy protocol, without a corresponding increase in pulmonary morbidity. This study suggests that appropriate oxygen therapy may play a role in inhibiting progression of stage 2 ROP, potentially decreasing the risk of lifelong visual loss in this vulnerable population.
The Effect of Oxygen Therapy on the Development of Retinopathy of Prematurity
Paediatrics Today, 2015
The aim of this study is to show the effect of oxygen therapy in premature babies on the development of severe ROP. Materials and methods-This retrospective research covered a period of two years, and included 108 premature babies, with birth weight <1500 g and gestational age <33 weeks, at the Children's Ward of the University Hospital Clinical Centre, Banja Luka. The effects of the length of oxygen therapy and episodes of hypoxia and hyperoxia on the development of severe ROP were analysed. Results-ROP was present in 64 (59.2%) newborns, of which 21 (19.4%) had severe ROP. The incidence of severe ROP is statistically higher with lower birth weight, <1150 g (p<0.01), lower gestational age <30 weeks, longer oxygen therapy and when there were frequent episodes of hyperoxia and hypoxia. By multiple logistic regression analysis, a very strong connection was established between severe ROP and exposure to episodes of hyperoxia (OR 32.73; CI 4.14-255.37), episodes of hypoxia (OR 14.08; CI 3.81-51.94), and oxygen therapy longer than 10 days (OR 15.54; CI 1.99-120.79). For most risk factors tested, there was a strong connection between severe ROP and birth weight <1250 g, gestational age <30 weeks, respiratory distress syndrome and perinatal asphyxia. Conclusion-Long-term oxygen therapy, prematurity and low birth weight with hypoxia are important factors in the development of severe ROP. Constant education is necessary of staff regarding the potentially harmful effects of oxygen in order to prevent both hypoxia and hyperoxia.
Frontiers in Pediatrics
Strategies to ensure high intraocular oxygen delivery to the developing retina after 32 weeks gestational age, such as higher saturation targets and/or higher hemoglobin levels, are hypothesized to prevent ophthalmological treatment for retinopathy of prematurity (ROP). This short report summarizes the current evidence of these strategies, and discusses possibilities of future studies. A large sample size would be required and therefore the feasibility of a future randomized controlled trial is questioned.
BMJ Open Ophthalmology, 2021
Objective An ongoing third epidemic of retinopathy of prematurity (ROP) is contributed largely by developing nations. We describe a cohort of infants in a single neonatal unit where two limits of oxygen saturation were administered, to show real-world outcomes from trend in neonatology for higher oxygen to improve survival. Methods and analysis This retrospective, comparative study of prospectively collected data in an ROP screening programme included infants indicated by gestational age ≤32 weeks, birth weight <1501 g, ventilation for 7 days or requiring oxygen >1 month, who underwent dilated fundoscopic examination from age 4 weeks, every 2 weeks until full retinal vascularisation. Infants with ROP were examined weekly and treated where indicated. Data were divided into two epochs. Epoch 1 oxygen saturation targets were [88–92%], epoch 2 targets [90–95% (99%)] with allowance of increase to 20% for several hours after procedures. Outcome measures included development of ROP, ...
Journal of Babol University of Medical Sciences, 2023
Background and Objective: Retinopathy of Prematurity (ROP), as a retinal vasoproliferative disease, is affected by the incomplete development of the respiratory system of premature babies. Since premature babies suffering from ROP have a lower level of partial pressure of oxygen (PO2), the present study was conducted to investigate the effect of PO2 and venous oxygen saturation in treatment response of ROP patients. Methods: This retrospective cohort study (2010-2020) was conducted in the neonatal intensive care unit of Ayatollah Rouhani hospital in Babol among 502 premature babies (less than 34 weeks of pregnancy and with a birth weight of less than 2500 grams). ROP was diagnosed and determined by an ophthalmologist based on the ICROP index on the first day of birth. Data related to PO2 and venous oxygen saturation were collected from patients' files. After receiving standard treatment for ROP, patients were examined and compared in two groups of “completely cured” and “other patients” (including partial recovery, no change, and disease progression) in terms of the effect of PO2 and venous oxygen saturation on the decrease or increase in stage (I to IV) and zone (I, II, III). Findings: Of the 502 babies examined, 193 had stage I, 232 had stage II, 76 had stage III, 1 had stage IV, and 55 had zone I, 245 had zone II, and 202 had zone III involvement. The mean level of PO2 and oxygen saturation between the two groups of “completely cured” patients and “other patients” did not have a statistically significant difference. The mean level of PO2 and oxygen saturation between the three groups of patients with partial recovery, patients with no change and patients with disease progression did not show a statistically significant difference. Furthermore, the levels of PO2 and venous oxygen saturation were not related to the change of stage and zone in patients with ROP. Conclusion: The results of the study showed that lack of oxygen is effective in causing ROP and oxygen therapy has an effective role in the treatment of ROP patients, but the amount of oxygen at the beginning of ROP diagnosis is not related to the treatment process of ROP.
Physiologic reduced oxygen protocol decreases the incidence of threshold retinopathy of prematurity
Transactions of the American Ophthalmological Society
To report the incidence of threshold retinopathy of prematurity (ROP) in very low birth weight premature infants from three neonatal intensive care units (NICUs) before and after implementation of a physiologic reduced oxygen protocol (PROP). PROSPECTIVE, OBSERVATIONAL STUDY OF DATA FROM THREE NICUS: Cedars-Sinai Medical Center (CSMC), Los Angeles; Good Samaritan Hospital (GSH), Los Angeles; and National University Hospital (NUH), Singapore. PROP was implemented to keep oxygen saturation values by pulse oximeter (SpO2) between 83% and 93% (as described in Pediatrics 2003;111:339-345). The incidence of threshold ROP in the year before and the year after implementation of PROP was compared. Data from the transition year were not included in the analysis. THE INCIDENCE OF THRESHOLD ROP DECREASED IN EACH CENTER: CSMC, 3.3% to 0.0% (3/92 to 0/88); GSH, 14.8% to 4.9% (8/54 to 2/41); and NUH, 6.7% to 0.0% (3/45 to 0/30). Overall, the incidence of threshold ROP decreased from 7.3% to 1.3%. ...
Transactions of the American Ophthalmological Society, 2006
To report the incidence of threshold retinopathy of prematurity (ROP) in very low birth weight premature infants from three neonatal intensive care units (NICUs) before and after implementation of a physiologic reduced oxygen protocol (PROP). PROSPECTIVE, OBSERVATIONAL STUDY OF DATA FROM THREE NICUS: Cedars-Sinai Medical Center (CSMC), Los Angeles; Good Samaritan Hospital (GSH), Los Angeles; and National University Hospital (NUH), Singapore. PROP was implemented to keep oxygen saturation values by pulse oximeter (SpO2) between 83% and 93% (as described in Pediatrics 2003;111:339-345). The incidence of threshold ROP in the year before and the year after implementation of PROP was compared. Data from the transition year were not included in the analysis. THE INCIDENCE OF THRESHOLD ROP DECREASED IN EACH CENTER: CSMC, 3.3% to 0.0% (3/92 to 0/88); GSH, 14.8% to 4.9% (8/54 to 2/41); and NUH, 6.7% to 0.0% (3/45 to 0/30). Overall, the incidence of threshold ROP decreased from 7.3% to 1.3%. ...
Eye, 1995
One hnndred and thirteen consecutive infants with a very low birthweight of less than 1500 g were followed prospectively for 6 months to determine the incidence of retinopathy of prematurity (ROP) and associated risk factors. Of this group, 36 (31.9%) infants devel oped ROP (13 infants had stage 1 ROP, nine had stage 2, six had stage 3, six had stage 4, and two had cicatricial stage ROP). Stepwise logistic regression analysis of various potential risk factors (birthweight, gestation, duration of oxygen therapy, duration of ventilation, highest documented Pa02 and exchange transfusion) showed that only two risk factors were significantly associated with the development of ROP. These risk factors were: the duration of oxygen therapy (p = 0.0005) and exchange transfusion during the neonatal period (odds ratio 5.754, 95% confidence interval 1.002 to 32.997, P = 0.049). The equation of the regression model is: log (odds of developing ROP) = -0.8395 + 0.1447 (OXY) -0.8750 (ET), where OXY is the duration of oxygen therapy in days, ET = -1 when there was a history of exchange transfusion, and ET = 1 when there was no history of exchange transfusion. Retinopathy of prematurity (ROP) is a vasopro liferative retinopathy which occurs primarily but not exclusively in preterm babies with immature retinal vasculature.1 Numerous risk factors occurring during the neonatal period have been implicated as being From:
JAMA Ophthalmology, 2019
(SUPPORT) demonstrated that static low oxygen saturation decreased retinopathy of prematurity (ROP) but increased mortality compared with static high oxygen saturation cohorts. OBJECTIVE To compare outcomes of a biphasic oxygen protocol with static targets recommended by SUPPORT. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study comparing biphasic vs static standards 41 months prior to and 42 months after a change from biphasic to static SUPPORT standards at a level III neonatal intensive care unit (Fairview Hospital, Cleveland, Ohio). The study included infants born at a corrected gestational age (CGA) of 31 weeks or younger or birth weight 1500 g or less. Data were analyzed between August 2010 and July 2017. INTERVENTIONS The pre-SUPPORT group underwent biphasic protocol target saturations of 85% to 92% at younger than 34 weeks' CGA and greater than 95% at 34 weeks' CGA or older. The post-SUPPORT group underwent a constant 91% to 95% target. MAIN OUTCOMES AND MEASURES Primary outcome was incidence of type 1 ROP. Secondary outcomes were incidence of any ROP, time to full vascularization, and mortality. RESULTS Of 596 eligible infants, 562 were included in ophthalmic analysis. Three hundred three patients were boys (54%); 399 were white (71%), 87 were black (15%), and 76 were of other or unknown race/ethnicity (14%). Mean (SD) CGA and birth weight were 29 (2) weeks and 1151 (346) g, respectively. Any ROP overall increased (53 [20%] pre-SUPPORT vs n = 86 [28%] post-SUPPORT; absolute difference, 8%; 95% CI, 1%-15%; odds ratio, 1.6; 95% CI, 1.05-2.3; P = .03). Type 1 ROP increased in the post-SUPPORT era (n = 6 [2%] pre-SUPPORT vs n = 18 [6%] post-SUPPORT; absolute difference, 4%; 95% CI, 0.4%-7%; odds ratio, 2.7; 95% CI, 1.05-6.9; P = .03). There was a delay in vascularization in the post-SUPPORT group (n = 6 [2%] pre-SUPPORT vs n = 18 [6%] post-SUPPORT; absolute difference, 4%; 95% CI, 0.4%-7%; P = .03). CONCLUSIONS AND RELEVANCE Compared with static oxygen standards, biphasic oxygen targets are associated with decreased incidence and severity of ROP without increasing mortality.