Strategies to Prevent Severe Retinopathy of Prematurity: A 2020 Update and Meta-analysis

Area of Science:

• Neonatal Medicine
• Ophthalmology

Background:

• The incidence of retinopathy of prematurity (ROP) is rising, particularly in extremely preterm infants (<25 weeks' gestation).
• This trend may be linked to increased survival rates of extremely preterm infants and the adoption of higher oxygen saturation targets.
• Current American Academy of Pediatrics guidelines recommend 90%-95% oxygen saturation for extremely low-birthweight infants, a practice potentially contributing to ROP's rise.

Purpose of the Study:

• To review and meta-analyze existing literature on retinopathy of prematurity (ROP).
• To evaluate strategies for decreasing ROP incidence without increasing mortality in preterm infants.
• To assess the impact of oxygen saturation targets and nutritional interventions on ROP.

Main Methods:

• Review of five randomized clinical trials comparing low versus high oxygen saturation targets.
• Analysis of two new cohort trials suggesting gradual increases in oxygen saturation targets.
• Meta-analysis of evidence regarding human milk, vitamin A, and omega-3 fatty acids for ROP prevention.

Main Results:

• High oxygen saturation targets were associated with an increased incidence of ROP.
• Low oxygen saturation targets in trials led to increased mortality.
• Evidence suggests human milk, vitamin A, and omega-3 fatty acids may reduce ROP risk.

Conclusions:

• Higher oxygen saturation targets may contribute to the increasing incidence of retinopathy of prematurity in extremely preterm infants.
• Gradually increasing oxygen saturation targets as preterm infants mature is a potential strategy to decrease ROP without increasing mortality.
• Nutritional interventions and continuous monitoring are important adjuncts in managing ROP risk.