Use of a Supplemental Oxygen Protocol to Suppress Progression of Retinopathy of Prematurity.
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.



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 χ2, 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.



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 = 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 = 0.0013), compared to cohort A, correcting for differences in birth weight and necrotizing enterocolitis.



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.
Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States.
Tarah T
TT
Colaizy
Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States.
Susannah
S
Longmuir
Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States.
Kevin
K
Gertsch
Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, United States 3Veterans Affairs Medical Center, Iowa City, Iowa, United States.
Michael David
MD
Abràmoff
Stead Family Department of Pediatrics, University of Iowa, Iowa City, Iowa, United States.
Jonathan M
JM
Klein
D018450:Disease Progression; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D016015:Logistic Models; D008297:Male; D010102:Oxygen Inhalation Therapy; D012178:Retinopathy of Prematurity / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors