Oxygen Saturation Targeting and Retinopathy Management in Very Preterm Neonates: An International Survey

Variation in the uptake of evidence-based practices and adoption of unproven therapies by neonatal intensive care units (NICUs) might contribute to clinical variability. The objective was to survey current oxygen saturation targets (SpO₂), the use of automatic adjustment of inspired oxygen in infants on respiratory support, the criteria for routine retinal examinations for retinopathy of prematurity (ROP), and the use of anti-vascular endothelial growth factor (VEGF) agents to treat ROP in the International Network for Evaluating Outcomes for Neonates (iNeo).

Online pre-piloted anonymous questionnaires on care practices in 2023 for extremely preterm (<29 weeks) infants were sent to the directors of 608 NICUs in the iNeo. Four questions concerned ROP management and results were compared with a similar 2015 survey.

There were 11 participating networks from 12 high-income countries and one from a middle-income country. The overall NICU response rate was 63% (382 units). Despite variability between NICUs, within networks, there was limited change in SpO₂ targets between 2015 and 2023. The median upper and lower SpO₂ targets were 95% and 89%; in 18% of NICUs, the upper target was ≥96%, and in 13%, the lower target was ≤85%. Automated loop systems for controlled oxygen delivery were used in 24% of NICUs. Most NICUs (78%) used a combination of birthweight and gestation as ROP screening criteria. Intravitreal anti-VEGF agents were used to treat ROP in all networks and by 76% of NICUs.

There was considerable variation in care practices between NICUs, and the relationship of this to clinical outcomes should be explored.