Oxygen management and targeted methods to Attack Retinopathy of Prematurity (ROP): Progress and Possibilities

Retinopathy of prematurity (ROP) is an eye disease that severely impacts premature infants, especially those born before 31 weeks gestation and those born at very low birth weights (≤1,500g). In this brief review we provide an overview of current challenges in reducing ROP, the methods used to treat ROP and mitigate its impact, the importance of close management of oxygen and respiratory strategies for best outcome in these infants. We highlight gaps that need further research and provide suggestions for future research and changes in treatment strategy to reduce ROP and improve outcomes in preterm infants at risk for severe ROP. Feedback controlled ventilation to maintain peripheral tissue oxygenation (SpO2, measured by pulse-oximetry) between 89 to 92% is a key component of our proposed strategy. This will require a control system that does not only depend on human intervention and, most likely, will require predictive algorithms based on machine learning (ML) methods to provide the most stringent adherence to this goal.