Comparative cohorts of retinopathy of prematurity outcomes of differing oxygen saturation: real-world outcomes

• Main Authors: Choo, May May, Grigg, John, Barnes, Elizabeth H., Khaliddin, Nurliza, Kamalden, Tengku Ain, Kamar, Azanna Ahmad, Choo, Yao Mun, Lim, Chin Theam, Martin, Frank Joseph
• Format: Article
• Published: BMJ Publishing Group 2021
• Subjects: RE Ophthalmology
• Online Access: http://eprints.um.edu.my/34878/

Objective An ongoing third epidemic of retinopathy of prematurity (ROP) is contributed largely by developing nations. We describe a cohort of infants in a single neonatal unit where two limits of oxygen saturation were administered, to show real-world outcomes from trend in neonatology for higher oxygen to improve survival. Methods and analysis This retrospective, comparative study of prospectively collected data in an ROP screening programme included infants indicated by gestational age <= 32 weeks, birth weight <1501 g, ventilation for 7days or requiring oxygen >1 month, who underwent dilated fundoscopic examination from age 4 weeks, every 2 weeks until full retinal vascularisation. Infants with ROP were examined weekly and treated where indicated. Data were divided into two epochs. Epoch 1 oxygen saturation targets were 88-92%], epoch 2 targets 90-95% (99%)] with allowance of increase to 20% for several hours after procedures. Outcome measures induded development of ROP, treatment, mortality, sepsis and intraventricular haemorrhage. Results A total of 651 infants underwent examination between 2003 and 2016. The incidence of ROP in epoch 1 was 29.1% and epoch 2 was 29.3% (p=0.24). ROP progression doubled in epoch 2 (5 vs 11%, p=0.006), proportion of cases treated halved (14% vs 6%, p=0.0005), sepsis was halved (78.5% vs 41.2%, p<0.0001) and intraventricular haemorrhage doubled (20.2% vs 43.8%, p=0.0001) in epoch 2. Mortality was 4% and 0% in epochs 1 and 2, respectively. Conclusion Incidence of ROP did not differ, although ROP cases that worsened doubled with higher oxygen targets. ROP cases requiring treatment decreased, as did sepsis and mortality. Intraventricular haemorrhage cases doubled.