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The relationship between patterns of intermittent hypoxia and retinopathy of prematurity in preterm infants
Juliann M Di Fiore1, Farhad Kaffashi, Kenneth Loparo
1Department of Pediatrics, Rainbow Babies & Children's Hospital, Case Western Reserve University, Cleveland, Ohio, USA. jmd3@cwru.edu
Insights
Intermittent hypoxemia (IH) patterns, including duration and variability, are linked to retinopathy of prematurity (ROP) severity in preterm infants. Analyzing oxygen saturation (SpO2) waveforms may aid early ROP risk identification.
Area of Science:
- Neonatal physiology
- Ophthalmology
- Cardiorespiratory monitoring
Background:
- Previous research indicated a higher occurrence of intermittent hypoxemia (IH) in preterm infants suffering from severe retinopathy of prematurity (ROP).
- Animal studies suggest IH event patterns might influence ROP severity.
Purpose of the Study:
- To investigate the association between specific intermittent hypoxemia (IH) event patterns and the development of retinopathy of prematurity (ROP) in preterm infants.
Main Methods:
- Assessed variability in IH event duration, severity, and time intervals between events (≤80%, ≥10 s, ≤3 min).
- Analyzed the frequency spectrum of oxygen saturation (SpO2) waveforms.
Main Results:
- Severe ROP correlated with increased mean and standard deviation of IH event duration (P < 0.005).
- Greater variability in the time interval between IH events (P < 0.005) and a higher IH nadir (P < 0.05) were observed.
- Specific time intervals (1-20 min) and spectral power in the 0.002-0.008 Hz range (P < 0.05) were associated with severe ROP, detected as early as 14 days of life.
Conclusions:
- More variable, longer, and less severe IH events are associated with severe ROP.
- Identifying specific spectral components in SpO2 waveforms could aid in the early detection of infants at risk for severe ROP.
Background:
We have previously shown an increased incidence of intermittent hypoxemia (IH) events in preterm infants with severe retinopathy of prematurity (ROP). Animal models suggest that patterns of IH events may play a role in ROP severity as well. We hypothesize that specific IH event patterns are associated with ROP in preterm infants.
Methods:
Variability in IH event duration, severity, and the time interval between IH events (≤80%, ≥10 s, and ≤3 min) along with the frequency spectrum of the oxygen saturation (SpO2) waveform were assessed.
Results:
Severe ROP was associated with (i) an increased mean and SD of the duration of IH event (P < 0.005), (ii) more variability (histogram entropy) of the time interval between IH events (P < 0.005), (iii) a higher IH nadir (P < 0.05), (iv) a time interval between IH events of 1-20 min (P < 0.05), and (v) increased spectral power in the range of 0.002-0.008 Hz (P < 0.05), corresponding to SpO2 waveform oscillations of 2-8 min in duration. Spectral differences were detected as early as 14 d of life.
Conclusion:
Severe ROP was associated with more variable, longer, and less severe IH events. Identification of specific spectral components in the SpO2 waveform may assist in early identification of infants at risk for severe ROP.
