A cohort study of transcutaneous oxygen tension and the incidence and severity of retinopathy of prematurity.
BACKGROUND
Retinopathy of prematurity is a disease affecting the blood vessels of the retina in premature infants that may result in scarring, retinal detachment, and loss of vision. An association between this condition and the exposure of premature infants to supplemental oxygen has been postulated, but the relation between retinopathy of prematurity and blood oxygen levels has not been defined. The purpose of this study of a cohort of preterm infants was to correlate the incidence and severity of retinopathy of prematurity with the duration of exposure to different ranges of oxygen tension as measured by transcutaneous monitoring (tcPO2).


METHODS
One hundred one premature infants (birth weight, 500 to 1300 g) requiring supplemental oxygen had continuous monitoring of tcPO2. The number of hours during which the tcPO2 was 80 mm Hg or higher was tabulated for each infant during the first four weeks of life.


RESULTS
There was a significant association between the amount of time that the tcPO2 was greater than or equal to 80 mm Hg and the incidence and severity of retinopathy of prematurity. The odds ratio for each 12-hour period in which the tcPO2 was greater than or equal to 80 mm Hg was 1.9 (95 percent confidence interval, 1.2 to 3.0) after adjustment for the following factors: birth weight less than or equal to 1300 g (odds ratio, 2.3 [95 percent confidence interval, 1.6 to 3.4]), five-minute Apgar score of 7 or less (odds ratio, 7.2 [95 percent confidence interval, 2.5 to 21]), and exposure to inspired oxygen at a concentration greater than or equal to 0.4 (odds ratio, 1.0 [95 percent confidence interval, 0.97 to 1.05]). The association was stronger for tcPO2 values of greater than or equal to 80 mm Hg occurring from the second through the fourth week of life; during this period, the adjusted odds ratio for a 12-hour period of such exposure was 3.1 (95 percent confidence interval, 1.6 to 6.1).


CONCLUSIONS
This study supports an association between the incidence and severity of retinopathy of prematurity and the duration of exposure to arterial oxygen levels of 80 mm Hg or higher, measured transcutaneously.
Flynn
J T
JT
Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, FL 33101.
Bancalari
E
E
Snyder
E S
ES
Goldberg
R N
RN
Feuer
W
W
Cassady
J
J
Schiffman
J
J
Feldman
H I
HI
Bachynski
B
B
Buckley
E
E
D001034:Apgar Score; D001724:Birth Weight; D001785:Blood Gas Monitoring, Transcutaneous; D015331:Cohort Studies; D005069:Evaluation Studies as Topic; D006801:Humans; D007231:Infant, Newborn; D016017:Odds Ratio; D010102:Oxygen Inhalation Therapy / Q000009:adverse effects; D012178:Retinopathy of Prematurity / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology; D012720:Severity of Illness Index; D013997:Time Factors