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Supplemental oxygen may decrease progression of prethreshold disease to threshold retinopathy of prematurity
M W Gaynon1, D K Stevenson, P Sunshine
1Department of Ophthalmology, Stanford University, Calif., USA.
Insights
Higher oxygen saturation levels in premature infants with retinopathy of prematurity (ROP) correlated with a decreased rate of disease progression. This suggests a potential benefit of increased oxygenation in managing ROP.
Area of Science:
- Ophthalmology
- Neonatology
- Perinatal Medicine
Background:
- The optimal oxygen saturation for premature infants with prethreshold retinopathy of prematurity (ROP) remains undetermined.
- Historical data shows stepwise increases in target oxygen saturation levels over time.
Purpose of the Study:
- To investigate the relationship between varying oxygen saturation levels and the progression rate of prethreshold ROP.
- To evaluate the impact of different oxygen saturation targets on the conversion of prethreshold ROP to threshold ROP.
Main Methods:
- Retrospective analysis of 153 infants with prethreshold ROP at Stanford University (1985-1993).
- Review of 26 infants (1994-1996) excluded from the STOP-ROP study.
- Tabulation of infant characteristics and calculation of ROP progression rates.
Main Results:
- Progression rates to threshold ROP were stable (average 37%) from 1985-1989.
- A significant drop in progression to 7% was observed between 1990-1993 when target saturation increased to 99%.
- Progression rates increased to 38% from 1994-1996.
Conclusions:
- Targeting higher oxygen saturation (99%) in infants with prethreshold ROP was associated with a decreased rate of progression.
- Moderate supplemental oxygen did not appear to arrest retinal vascular maturation.
- Further research is warranted to establish definitive oxygenation guidelines for ROP management.
Abstract:
The optimum level of oxygen saturation for infants with prethreshold retinopathy of prematurity (ROP) is unknown. We reviewed our conversion rate from prethreshold to threshold ROP between 1985 and 1993 during which time target levels of oxygen saturation rose in a stepwise fashion. A retrospective study of 153 infants with prethreshold ROP was performed at Stanford University between 1985 and 1993 that showed that target minimum oxygen saturation rose from 92% (1985-1987) to 95% (1988) to 96% (1989) to 99% (1990-1993). In addition, we looked at 26 infants between 1994 and 1996 who were excluded from the STOP-ROP study and who were not receiving supplemental oxygen in an effort to maintain equipoise for that study. Infant characteristics were tabulated, and rates of progression from prethreshold to threshold ROP were calculated. Rates of progression to threshold varied little between 1985 and 1989 (average 37%), but dropped to 7% for the period between 1990 and 1993. From 1994 through 1996 the rate of progression to threshold disease rose again, to 38%. Moderate supplemental oxygen (target saturation 99% with PO2 no higher than 100 mm Hg) was associated with regression of prethreshold ROP, without appearing to arrest retinal vascular maturation.
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