Increased risk of retinopathy of prematurity since increased O₂ saturation targets: A multi-centre study

Area of Science:

• Neonatal Medicine
• Ophthalmology
• Public Health

Background:

• Retinopathy of prematurity (ROP) is a primary cause of visual impairment in premature infants.
• Recent oxygen (O2) saturation target increases in neonates, recommended by major trials, aim to reduce mortality but are a known risk factor for ROP.
• The study investigates the impact of these updated O2 guidelines on ROP prevalence.

Purpose of the Study:

• To determine if higher oxygen saturation targets in preterm neonates have increased the prevalence of retinopathy of prematurity (ROP).
• To assess the risk of ROP in higher-risk subgroups of preterm neonates under the new oxygen guidelines.

Main Methods:

• A retrospective cohort study analyzed data from 17,298 neonates born before 32 weeks' gestational age (GA) and/or weighing less than 1500g between 2012-2018.
• Adjusted odds ratios (aORs) were calculated for ROP risk (any ROP, ROP ≥ Stage 2, treated ROP) in the post-2015 period.
• Sub-analyses were performed for neonates with GA <28 weeks, <26 weeks, birth weight <1500g, and <1000g.

Main Results:

• The risk of any ROP significantly increased post-2015 (aOR=1.23) and in preterm infants with GA <28 weeks (aOR=1.31), <26 weeks (aOR=1.57), <1500g (aOR=1.24), and <1000g (aOR=1.34).
• ROP ≥ Stage 2 also showed increased risk in infants with GA <28 weeks (aOR=1.30), <26 weeks (aOR=1.57), <1500g (aOR=1.18), and <1000g (aOR=1.26).

Conclusions:

• Current oxygen therapy guidelines implemented since 2015 have led to reduced mortality but concurrently increased the incidence of ROP.
• Individualized adjustments in ROP screening and follow-up protocols within neonatal intensive care units (NICUs) are crucial to manage the clinical burden of ROP.