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Prevention of retinopathy of prematurity in preterm infants through changes in clinical practice and SpO₂technology
Armando Castillo1, Richard Deulofeut, Ann Critz
1Northeast Georgia Medical Center, Gainesville, USA.
Insights
Pulse oximetry technology, specifically Masimo SET, combined with clinical practice changes, significantly reduced severe retinopathy of prematurity (ROP) and laser treatment needs in premature infants. This highlights the importance of selecting appropriate pulse oximetry devices.
Area of Science:
- Neonatal ophthalmology
- Medical technology assessment
- Premature infant care
Background:
- Retinopathy of prematurity (ROP) is a significant cause of vision impairment in premature infants.
- Pulse oximetry is crucial for monitoring oxygen saturation in these vulnerable infants.
- Different pulse oximetry technologies may impact clinical outcomes.
Purpose of the Study:
- To determine if specific pulse oximetry technology is associated with reduced rates of severe retinopathy of prematurity (ROP).
- To evaluate the impact of pulse oximetry technology on the need for laser treatment for ROP.
- To compare outcomes between different pulse oximetry devices in premature infants.
Main Methods:
- A comparative study of inborn infants weighing less than 1250g across three time periods and two centers.
- Implementation of varying SpO2 targets (≥93% and 88-93%) and introduction of Masimo Signal Extraction Technology (SET) pulse oximetry at one center.
- Standardized eye examinations using international criteria were performed by a single ophthalmology department.
Main Results:
- At the center using Masimo SET, severe ROP decreased from 12% to 5%, and laser treatment needs dropped from 5% to 3% after implementing lower SpO2 targets.
- The other center, without Masimo SET during the initial comparison period, showed no significant decrease in severe ROP or laser treatment.
- Birth weight and gestational age were consistent across all groups, ensuring comparability.
Conclusions:
- The combination of clinical practice changes and Masimo SET pulse oximetry technology led to a significant reduction in severe ROP and laser therapy.
- Pulse oximetry device selection is a critical factor in managing oxygenation and preventing ROP in critically ill premature infants.
- The findings underscore the importance of advanced monitoring technology in neonatal intensive care.
Aim:
To identify whether pulse oximetry technology is associated with decreased retinopathy of prematurity (ROP) and laser treatment.
Methods:
Inborn infants <1250 g who had eye exams were compared at two centres in three periods. In Period 1, SpO₂ target was ≥93% and pulse oximetry technology was the same in both Centres. In Period 2, guidelines for SpO₂ 88-93% were implemented at both centres and Centre B changed to oximeters with signal extraction technology (SET(®)) while Centre A did not, but did so in Period 3. One ophthalmology department performed eye exams using international criteria.
Results:
In 571 newborns <1250 g, birth weight and gestational age were similar in the different periods and centres. At Centre A, severe ROP and need for laser remained the same in Periods 1 and 2, decreasing in Period 3-6% and 3%, respectively. At Centre B, severe ROP decreased from 12% (Period 1) to 5% (Period 2) and need for laser decreased from 5% to 3%, remaining low in Period 3.
Conclusion:
In a large group of inborn infants <1250 g, a change in clinical practice in combination with pulse oximetry with Masimo SET, but not without it, led to significant reduction in severe ROP and need for laser therapy. Pulse oximetry selection is important in managing critically ill infants.
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