Effects of increase in neonatal intensive care unit O2 saturation targets on rates of retinopathy of prematurity: A multi-centre study

Abstract

Purpose: It has been noted by some studies that the increase in oxygen saturations >90% has been associated with increased rates and severity of retinopathy of prematurity (ROP). However, these studies are limited by small sample size. Our study aims to determine whether introduction of higher O2 saturation targets has resulted in increased rate or severity of ROP within preterm infants. Methods: A retrospective review analysing data collected by the Australian and New Zealand Neonatal Network for infants <32 weeks gestational age (GA) and/or <1500 g birth weight born between the years 2012-2018 was conducted. Results: Approximately 29,000 infant records were reviewed. After exclusion criteria, a final cohort of 17,298 was subject to analysis. A significant increase in hours of O2 therapy exposure was noted for infants post-2015 (p < 0.01). ROP prevalence increased post-2015, both of any type (OR = 1.25, p ≤ 0.01) and of Grades 2 or higher (odds ratio [OR] = 1.21, p < 0.01) compared to pre 2015 levels. ROP requiring treatment was also observed to have increased (OR = 1.33, p < 0.01). Stratification based on GA demonstrated that the increase remained significant for infants born at <28 weeks (OR = 1.23, p < 0.01), but not for older infants. Conclusion: New guidelines for O2 therapy introduced since the BOOST II, SUPPORT and COT trials appear to have resulted in increased ROP prevalence in very pre-term infants born at <28 GA. Further adjustment of guidelines to minimise duration of oxygen therapy while maintaining the survivability benefits is advised.L6366696662021-12-27 <br />