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Daily Oxygen Supplementation and Risk of Retinopathy of Prematurity
Marcela M Estrada1, Lauren A Tomlinson2, Yinxi Yu3
1Department of Ophthalmology, University of California, Sacramento, California, USA.
Insights
A new measure of daily oxygen supplementation (DSO) in the first 28 days can help predict retinopathy of prematurity (ROP). This simple screening tool improves ROP prediction accuracy in neonatal intensive care units.
Area of Science:
- Neonatal care
- Ophthalmology
- Perinatal medicine
Background:
- Excessive oxygen supplementation is a significant risk factor for retinopathy of prematurity (ROP).
- Current methods for predicting ROP are often complex and impractical for routine clinical screening.
- There is a need for a simple, effective measure to identify infants at risk for ROP.
Purpose of the Study:
- To develop a simple, clinically useful measure of daily oxygen supplementation (DSO) during the first 28 days of life.
- To improve the prediction of ROP using this new measure.
- To assess the efficacy of DSO in screening criteria for ROP.
Main Methods:
- Secondary analysis of two Postnatal Growth and ROP (G-ROP) Study cohorts.
- Inclusion of infants with known ROP outcomes and complete oxygen data from 45 hospitals.
- Assessment of the association between severe ROP and DSO28, controlling for birth weight (BW) and gestational age (GA).
- Development and comparison of new screening criteria incorporating DSO against current guidelines.
Main Results:
- Among 8,949 infants, 5.1% developed type 1 ROP.
- DSO28 was significantly associated with severe ROP (adjusted-OR 1.05 per day, p < .0001).
- New screening criteria incorporating DSO demonstrated 100% sensitivity for type 1 ROP with improved specificity compared to current guidelines, reducing the number of infants examined.
Conclusions:
- Incorporating DSO into screening criteria enhances sensitivity and specificity for type 1 ROP in high-level neonatal care settings.
- The DSO measure offers a practical improvement over current Birth Weight-Gestational Age (BW-GA) criteria.
- While effective, DSO-based criteria did not outperform the validated G-ROP criteria in this study.
Purpose:
Excessive oxygen supplementation increases risk of retinopathy of prematurity (ROP). While numerous oxygen parameters could be considered when predicting ROP (saturation targets, actual saturation, fraction of inspired oxygen, etc.), complicated measures are impractical as screening criteria. We sought to develop a simple, clinically useful measure of daily oxygen supplementation during ages 0-28 days to improve prediction of ROP.
Methods:
Secondary analysis of two Postnatal Growth and ROP (G-ROP) Study cohorts (G-ROP-1 and G-ROP-2) at 45 hospitals. Infants with a known ROP outcome and complete oxygen data were included. Associations between severe ROP and days on supplemental oxygen (FiO2 > 21%), during ages 0-28 days (DSO28) were assessed, controlling for birth weight (BW) and gestational age (GA). New screening criteria incorporating DSO were developed and compared to current guidelines.
Results:
Among 8,949 studied infants, 459 (5.1%) developed type 1 ROP. DSO28 was associated with severe ROP (adjusted-OR 1.05 per day supplemental oxygen, 95%CI 1.03-1.07, p < .0001). The following criteria had 100% sensitivity for type 1 ROP and higher specificity than current guidelines: new BW/GA criteria with DSO (BW<901 g, GA<26 weeks, or DSO >3), 23.4% fewer infants examined; modified G-ROP criteria including DSO, 29.0% fewer infants; original G-ROP criteria, 31.8% fewer infants.
Conclusion:
In high-level neonatal-care settings, incorporating DSO (a simple measure of oxygen supplementation) into screening criteria improves sensitivity and specificity for type 1 ROP over current BW-GA criteria, but does not perform as well as the validated G-ROP criteria.
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