The aim of this study was to investigate whether the mean around which arterial oxygen fluctuations take place was important in a unique animal model of oxygen-induced retinopathy. Retinopathy of prematurity (ROP) is associated with fluctuating arterial oxygen. A recent retrospective study suggested that management of high-risk preterm infants at lower oxygen saturations was associated with less severe ROP. Rat pups were raised in a variable oxygen environment around a high (24%), normal (21%) or low (17%) mean inspired oxygen for 14 d. Rat pups raised in the high (24%) mean variable oxygen environment had more retarded retinal vascular development than did rats raised in an environment that fluctuated around 21% mean oxygen. In contrast, rats raised in a lower mean (17%) but still variable oxygen environment had no discernible retinal differences from controls raised in constant room air. Rats raised in a relatively hypoxic but variable oxygen environment develop less severe retinal vascular abnormalities than those raised in variable oxygen around higher oxygen means. Abbreviations C, group raised in room air DAB, diaminobenzidine Hi, variable oxygen profile around 24% oxygen mean IQR, interquartile range Lo, variable oxygen profile around 17% oxygen mean N, variable oxygen profile around 21% oxygen mean PFA, paraformaldehyde ROP, retinopathy of prematurity TBS, Tris-buffered saline VEGF, vascular endothelial growth factor ROP is a leading cause of blindness among infants in developed (1) and middle-income countries (2). The role of high concentrations of supplemental oxygen was first recognized in the 1950s (3), and subsequent animal studies (4 -6) delineated the pathophysiology. Restrictions on oxygen use led to a reduction in the disease, but the technological advances in the 1970s and 1980s led to infants up to 16 wk preterm surviving. Even with strict oxygen control to prevent hyperoxia the disease incidence began to increase again. The cause of the current disease is generally considered multifactorial (7), however variations in oxygen have been shown important to the development of disease in humans (8, 9) and in animal models (10 -12).Current oxygen therapy for preterm neonates in our neonatal unit (Edinburgh, UK) provides a "safe" transcutaneous range of 6 -10 kPa (45-75 mm Hg). This is considered to minimize hyperoxia-associated ROP and to limit neurologic and pulmonary morbidity from associated hypoxia. However, there are few data to indicate whether these limits are appropriate. In "healthy" preterm infants (without lung disease) of 29 -34 wk gestation, Mok et al. (13) demonstrated a mean (range) of 9 kPa (4.7-10.9 kPa) [67.5 (35-82) mm Hg] over the first few months of life. However, no data are available for the gestations at risk for ROP currently (infants Ͻ 29 wk gestation).A recent retrospective case review suggested that babies Ͻ28 wk gestational age nursed in an oxygen saturation range of 70 -90% had a lower incidence of ROP (14)
ABSTRACT107 dence of cerebral palsy or adverse pulmonary out...