Retrolental Fibroplasia and Oxygen Therapy

A Cohort Study of Transcutaneous Oxygen Tension and the Incidence and Severity of Retinopathy of Prematurity

“…The association between hyperoxic exposure (tcPo2 3 80 mm Hg) during the first 4 weeks of life and the incidence and severity of ROP was explored using ordinal logistic regression (Table VI). The unadjusted odds ratio derived from an ordinal logistic regression model for a 12-hour increment in the hours of exposure to tcPo2 3 An analysis of the subgroup of infants weighing , 900 g was performed using dichotomous logistic regression to examine the relationship between the incidence of ROP (a diagnosis of ROP versus no ROP) and tcPo2 > 80 mm Hg (Table VII). This analysis was not performed in the smaller infants (< 900 g), since ROP developed in almost all (19 of 22 [86%]) of these infants.…”

“…Several studies in the 1950s have shown that premature infants treated with oxygen regimens of longer durations and/or higher concentrations of inspired oxygen had significantly more ROP than controls. [1][2][3] The Second National Cooperative Study of ROP,5 which took place between 1969 and 1972, was designed to identify the relationship of specific Pao2 levels and ROP. While that study was unable to demonstrate a relationship between Pao2 levels and ROP, it did confirm that longer durations of oxygen therapy were associated with the development of ROP in infants weighing < 1200 g at birth.…”

Pathogenesis and Management of Retinopathy of Prematurity in Premature Infants

“…Historical role of oxygen in the pathogenesis of ROP has been confirmed by clinical trials, demonstrating definitively the relationship between elevated oxygen and ROP and further that, by restricting supplemental oxygen use, could lead to increased mortality. [9][10][11] Pulse oximetry monitors oxygenation in infants non-invasively and continuously in infants, allowing titration of inspired oxygen to maintain desired oxygen saturations (SpO 2 ). In one of the earlier studies, higher SpO 2 (88-98%) in the first 8 weeks of life in infants born between 24 to 28 weeks gestational age, had four times higher rates of surgery for ROP compared to lower SpO 2 (70-90%) group.…”

A History of Neonatal Medicine—Past Accomplishments, Lessons Learned, and Future Challenges. Part 1—The First Century

“…The '50s and early '60s were the years of early starvation, when the first feeding was delayed for two to three days in sick or premature infants because of concerns about aspiration pneumonia 45 resulting in severe weight loss, frequently as great as 20%. In the '50s, with Jonathan Lanmann's recognition that hyperoxia was causing RLF, 46 restricted oxygen use caused increased deaths from respiratory distress and in the survivors an increased incidence of cerebral palsy. Two iatrogenic diseases related to drug use, the lethal "gray baby" syndrome (from the use of chloramphenicol in premature infants) and kernicterus (from sulfisoxazole prophylaxis) were identified and their pathogenesis clarified.…”