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Updated: Jan 29, 2026
Oxygen-Induced Retinopathy Model for Ischemic Retinal Diseases in Rodents
Published on: September 16, 2020
Comparison of Biphasic vs Static Oxygen Saturation Targets Among Infants With Retinopathy of Prematurity
Ankita Shukla1,2, Christine Sonnie3, Sarah Worley4
1Department of Pediatrics, Division of Neonatology, Cleveland Clinic, Cleveland, Ohio.
Insights
Biphasic oxygen protocols, unlike static targets, reduced retinopathy of prematurity (ROP) incidence and severity in premature infants without increasing mortality. This suggests a safer approach to oxygen management for vulnerable newborns.
Area of Science:
- Neonatal Intensive Care
- Pediatric Ophthalmology
- Respiratory Medicine
Background:
- The Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial (SUPPORT) highlighted risks of static low oxygen saturation in premature infants, including increased mortality.
- Static high oxygen saturation cohorts in SUPPORT showed decreased retinopathy of prematurity (ROP) but increased mortality.
- Optimal oxygen saturation targets for premature infants remain a critical area of research.
Purpose of the Study:
- To compare the outcomes of a biphasic oxygen protocol versus static oxygen targets in a neonatal intensive care unit.
- To evaluate the incidence of ROP, time to vascularization, and mortality under different oxygen saturation protocols.
Main Methods:
- A retrospective cohort study was conducted at a level III NICU, comparing infants before and after a protocol change from biphasic to static oxygen targets.
- Infants born at 31 weeks' corrected gestational age (CGA) or younger, or with birth weight 1500 g or less, were included.
- Data were analyzed from August 2010 to July 2017, comparing a biphasic protocol (85%-92% for <34 weeks CGA, >95% for ≥34 weeks CGA) with a static protocol (91%-95%).
Main Results:
- The incidence of any ROP increased significantly in the static SUPPORT group compared to the biphasic group (28% vs. 20%).
- Type 1 ROP incidence also rose in the static SUPPORT era (6% vs. 2%), as did the delay in retinal vascularization.
- No significant increase in mortality was observed between the two groups.
Conclusions:
- Biphasic oxygen targeting is associated with a decreased incidence and severity of ROP in premature infants.
- The biphasic approach appears to be a safer oxygen management strategy, reducing ROP without adversely affecting mortality.
- These findings suggest a potential shift in clinical practice towards more dynamic oxygen saturation targets for extremely preterm infants.
Importance:
The Surfactant, Positive Pressure, and Pulse Oximetry Randomized Trial (SUPPORT) demonstrated that static low oxygen saturation decreased retinopathy of prematurity (ROP) but increased mortality compared with static high oxygen saturation cohorts.
Objective:
To compare outcomes of a biphasic oxygen protocol with static targets recommended by SUPPORT.
Design, Setting, And Participants:
Retrospective cohort study comparing biphasic vs static standards 41 months prior to and 42 months after a change from biphasic to static SUPPORT standards at a level III neonatal intensive care unit (Fairview Hospital, Cleveland, Ohio). The study included infants born at a corrected gestational age (CGA) of 31 weeks or younger or birth weight 1500 g or less. Data were analyzed between August 2010 and July 2017.
Interventions:
The pre-SUPPORT group underwent biphasic protocol target saturations of 85% to 92% at younger than 34 weeks' CGA and greater than 95% at 34 weeks' CGA or older. The post-SUPPORT group underwent a constant 91% to 95% target.
Main Outcomes And Measures:
Primary outcome was incidence of type 1 ROP. Secondary outcomes were incidence of any ROP, time to full vascularization, and mortality.
Results:
Of 596 eligible infants, 562 were included in ophthalmic analysis. Three hundred three patients were boys (54%); 399 were white (71%), 87 were black (15%), and 76 were of other or unknown race/ethnicity (14%). Mean (SD) CGA and birth weight were 29 (2) weeks and 1151 (346) g, respectively. Any ROP overall increased (53 [20%] pre-SUPPORT vs n = 86 [28%] post-SUPPORT; absolute difference, 8%; 95% CI, 1%-15%; odds ratio, 1.6; 95% CI, 1.05-2.3; P = .03). Type 1 ROP increased in the post-SUPPORT era (n = 6 [2%] pre-SUPPORT vs n = 18 [6%] post-SUPPORT; absolute difference, 4%; 95% CI, 0.4%-7%; odds ratio, 2.7; 95% CI, 1.05-6.9; P = .03). There was a delay in vascularization in the post-SUPPORT group (n = 6 [2%] pre-SUPPORT vs n = 18 [6%] post-SUPPORT; absolute difference, 4%; 95% CI, 0.4%-7%; P = .03).
Conclusions And Relevance:
Compared with static oxygen standards, biphasic oxygen targets are associated with decreased incidence and severity of ROP without increasing mortality.
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