Incidence of severe retinopathy of prematurity before and after a modest reduction in target oxygen saturation levels.
BACKGROUND
Previous studies suggest that reducing target oxygen saturation levels to 85-93% decreases the incidence of severe retinopathy of prematurity (ROP). Our aim was to determine if a more modest reduction in target oxygen saturation levels also reduces ROP incidence.


METHODS
One neonatal intensive care unit instituted new oxygen saturation guidelines that changed target levels from the upper 90s to 90-96%. We conducted a retrospective cohort study to determine the proportion of eyes that progressed to (1) threshold or type-1 ROP and (2) stage 3. These proportions were compared between two groups of all eligible infants born up to 10 months before (higher oxygen group, n = 46) and up to 16 months after (lower oxygen group, n = 59) the policy change. Binomial regression was used to calculate relative risks adjusted for birth weight, gestational age, apnea, days of mechanical ventilation, and length of hospital stay.


RESULTS
Sixteen of 90 eyes (18%) in the higher oxygen group developed threshold or type-1 ROP versus 16 of 118 eyes (14%) in the lower oxygen group (adjusted relative risk = 0.66, 95% CI = 0.29, 1.51). Twenty-two of 88 eyes (25%) in the higher oxygen group developed stage 3 ROP versus 26 of 118 eyes (22%) in the lower oxygen group (adjusted relative risk = 0.76, 95% CI = 0.43, 1.37).


CONCLUSIONS
We observed a small but statistically insignificant reduction in the incidence of severe ROP after a modest reduction in target oxygen saturation levels to 90 to 96% in the first several weeks of life.
Wallace
David K
DK
Duke Eye Center, Durham, NC 27710, USA. david.wallace@duke.edu <david.wallace@duke.edu>
Veness-Meehan
Kathleen A
KA
Miller
William C
WC
D001724:Birth Weight; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D010101:Oxygen Consumption; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D012178:Retinopathy of Prematurity / Q000145:classification / Q000209:etiology* / Q000517:prevention & control*; D012189:Retrospective Studies