Incidence of severe retinopathy of prematurity before and after a modest reduction in target oxygen saturation levels

Wallace, David K.; Veness-Meehan, Kathleen A.; Miller, William C.

doi:10.1016/j.jaapos.2006.08.012

Cited by 44 publications

(38 citation statements)

References 18 publications

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“…48 The remaining 46% were part of a cohort study that frequently involved investigating ROP outcomes after a change in clinical management of supplemental oxygen. 49,51,[54][55][56][57][58][59][60][61][62] In these studies, the definition of "lower oxygen saturation target" varied from a low of 70% to 90% 62 to a high of 90% to 96%. 58 The definition of "higher oxygen saturation target" ranged from a low of 88% to 96% 49 to a high of 95% to 100%.…”

Section: Summary Of Evidencementioning

confidence: 99%

“…49,51,[54][55][56][57][58][59][60][61][62] In these studies, the definition of "lower oxygen saturation target" varied from a low of 70% to 90% 62 to a high of 90% to 96%. 58 The definition of "higher oxygen saturation target" ranged from a low of 88% to 96% 49 to a high of 95% to 100%. 56 Based on our meta-analysis, the risk of severe ROP or ROP requiring intervention was reduced by 40% using lower oxygen saturation targets as defined by each study.…”

Section: Summary Of Evidencementioning

confidence: 99%

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Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Fang¹,

Sorita²,

Carey³

et al. 2016

Pediatrics

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CONTEXT: The effectiveness of many interventions aimed at reducing the risk of retinopathy has not been well established. OBJECTIVE:To estimate the effectiveness of nutritional interventions, oxygen saturation targeting, blood transfusion management, and infection prevention on the incidence of retinopathy of prematurity (ROP). DATA SOURCES:A comprehensive search of several databases was conducted, including Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through March 2014. STUDY SELECTION:We included studies that evaluated nutritional interventions, management of supplemental oxygen, blood transfusions, or infection reduction and reported the incidence of ROP and mortality in neonates born at <32 weeks. DATA EXTRACTION:We extracted patient characteristics, interventions, and risk of bias indicators. Outcomes of interest were any stage ROP, severe ROP or ROP requiring treatment, and mortality. RESULTS:We identified 67 studies enrolling 21 819 infants. Lower oxygen saturation targets reduced the risk of developing any stage ROP (relative risk [RR] 0.86, 95% confidence interval [CI], 0.77-0.97) and severe ROP or ROP requiring intervention (RR 0.58, 95% CI, 0.45-0.74) but increased mortality (RR 1.15, 95% CI, 1.04-1.29). Aggressive parenteral nutrition reduced the risk of any stage ROP but not severe ROP. Supplementation of vitamin A, E, or inositol and breast milk feeding were beneficial but only in observational studies. Use of transfusion guidelines, erythropoietin, and antifungal agents were not beneficial. LIMITATIONS:Results of observational studies were not replicated in randomized trials. Interventions were heterogeneous across studies. CONCLUSIONS:At the present time, there are no safe interventions supported with high quality evidence to prevent severe ROP.

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Section: Summary Of Evidencementioning

confidence: 99%

Section: Summary Of Evidencementioning

confidence: 99%

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Fang¹,

Sorita²,

Carey³

et al. 2016

Pediatrics

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“…Oxygen exposure in this phase suppresses vascular endothelial growth factor (VEGF) expression, resulting in the cessation of normal vessel growth and regression of existing vessels, explaining the longstanding recognition that oxygen exposure in the first few weeks of life increases the likelihood of ROP occurrence [4][5][6][40][41][42][43][44] . Our finding that the risk of ROP in association with oxygen expo- 1 F rom univariate comparisons of children with one of the first 7 combinations of characteristics to infants without any of these.…”

Section: Oxygen Exposurementioning

confidence: 99%

Infection, Oxygen, and Immaturity: Interacting Risk Factors for Retinopathy of Prematurity

et al. 2010

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“…The use of controlled and limited SaO 2 induced a reduction in the incidence of severe ROP (22), but there was an increase in mortality (23). Wallance et al (24) tried to establish the incidence of severe ROP with the use of slightly reduced levels of oxygen saturation of 90-96% in the first few weeks of life. They noticed that there was a low statistical significance in the reduction of the incidence of severe ROP with the use of slightly lower oxygen saturation.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Oxygen Therapy on the Development of Retinopathy of Prematurity

Jojić¹,

Predojević-Samardžić²,

Mavija³

et al. 2015

Pedaiatr Today

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Objective -The aim of this study is to show the effect of oxygen therapy in premature babies on the development of severe ROP. Materials and methods -This retrospective research covered a period of two years, and included 108 premature babies, with birth weight <1500 g and gestational age <33 weeks, at the Children's Ward of the University Hospital Clinical Centre, Banja Luka. The effects of the length of oxygen therapy and episodes of hypoxia and hyperoxia on the development of severe ROP were analysed. Results -ROP was present in 64 (59.2%) newborns, of which 21 (19.4%) had severe ROP. The incidence of severe ROP is statistically higher with lower birth weight, <1150 g (p<0.01), lower gestational age <30 weeks, longer oxygen therapy and when there were frequent episodes of hyperoxia and hypoxia. By multiple logistic regression analysis, a very strong connection was established between severe ROP and exposure to episodes of hyperoxia (OR 32.73; CI 4.14-255.37), episodes of hypoxia (OR 14.08; CI 3.81-51.94), and oxygen therapy longer than 10 days (OR 15.54;. For most risk factors tested, there was a strong connection between severe ROP and birth weight <1250 g, gestational age <30 weeks, respiratory distress syndrome and perinatal asphyxia. Conclusion -Long-term oxygen therapy, prematurity and low birth weight with hypoxia are important factors in the development of severe ROP. Constant education is necessary of staff regarding the potentially harmful effects of oxygen in order to prevent both hypoxia and hyperoxia.

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Incidence of severe retinopathy of prematurity before and after a modest reduction in target oxygen saturation levels

Abstract: Background-Previous studies suggest that reducing target oxygen saturation levels to 85-93% decreases the incidence of severe retinopathy of prematurity (ROP). Our aim was to determine if a more modest reduction in target oxygen saturation levels also reduces ROP incidence.

Cited by 44 publications

References 18 publications

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Infection, Oxygen, and Immaturity: Interacting Risk Factors for Retinopathy of Prematurity

The Effect of Oxygen Therapy on the Development of Retinopathy of Prematurity

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