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Oxygen Saturation Targeting and Retinopathy Management in Very Preterm Neonates: An International Survey
Brian A Darlow1, Elizabeth M Hurrion2,3, Malcolm Battin4
1Department of Paediatrics, University of Otago, Christchurch, New Zealand.
Insights
Neonatal intensive care units show significant variation in oxygen saturation targets and Retinopathy of Prematurity (ROP) treatments. Exploring this variability
Area of Science:
- Neonatal intensive care
- Pediatric ophthalmology
- Clinical practice variation
Background:
- Clinical variability in neonatal intensive care units (NICUs) may stem from differing adoption of evidence-based practices versus unproven therapies.
- Understanding current practices in NICUs is crucial for standardizing care and improving outcomes for extremely preterm infants.
Purpose of the Study:
- To survey current oxygen saturation (SpO2) targets in extremely preterm infants.
- To assess the use of automatic adjustment of inspired oxygen, Retinopathy of Prematurity (ROP) screening criteria, and anti-vascular endothelial growth factor (VEGF) agents for ROP treatment.
- To compare 2023 practices with a 2015 survey within the International Network for Evaluating Outcomes for Neonates (iNeo).
Main Methods:
- Online, pre-piloted, anonymous questionnaires were distributed to 608 NICU Directors in the iNeo network in 2023.
- The survey focused on care practices for infants born before 29 weeks gestation.
- Four specific questions addressed ROP management, with results compared to a 2015 survey.
Main Results:
- A 63% response rate (382 NICUs) was achieved across 11 networks from 13 countries.
- Median SpO2 targets were 95% (upper) and 89% (lower), with significant variability (18% upper ≥96%, 13% lower ≤85%).
- Automated oxygen systems were used in 24% of NICUs; 78% used birthweight and gestation for ROP screening. Intravitreal anti-VEGF agents were used by 76% of NICUs.
Conclusions:
- Considerable variation in NICU care practices persists between and within networks.
- The relationship between these observed care variations and clinical outcomes warrants further investigation.
Introduction:
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).
Methods:
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.
Results:
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.
Discussion:
There was considerable variation in care practices between NICUs, and the relationship of this to clinical outcomes should be explored.
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