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Meta-Analysis
. 2010 Jun;125(6):e1483-92.
doi: 10.1542/peds.2009-2218. Epub 2010 May 24.

High or low oxygen saturation and severe retinopathy of prematurity: a meta-analysis

Minghua L Chen  1 , Lei Guo, Lois E H Smith, Christiane E L Dammann, Olaf Dammann
Affiliations
Meta-Analysis

High or low oxygen saturation and severe retinopathy of prematurity: a meta-analysis

Minghua L Chen et al. Pediatrics. 2010 Jun.

Abstract

Context: Low oxygen saturation appears to decrease the risk of severe retinopathy of prematurity (ROP) in preterm newborns when administered during the first few weeks after birth. High oxygen saturation seems to reduce the risk at later postmenstrual ages (PMAs). However, previous clinical studies are not conclusive individually.

Objective: To perform a systematic review and meta-analysis to report the association between severe ROP incidence of premature infants with high or low target oxygen saturation measured by pulse oximetry.

Methods: Studies were identified through PubMed and Embase literature searches through May 2009 by using the terms "retinopathy of prematurity and oxygen" or "retinopathy of prematurity and oxygen therapy." We selected 10 publications addressing the association between severe ROP and target oxygen saturation measured by pulse oximetry. Using a random-effects model we calculated the summary-effect estimate. We visually inspected funnel plots to examine possible publication bias.

Results: Low oxygen saturation (70%-96%) in the first several postnatal weeks was associated with a reduced risk of severe ROP (risk ratio [RR]: 0.48 [95% confidence interval (CI): 0.31-0.75]). High oxygen saturation (94%-99%) at > or = 32 weeks' PMA was associated with a decreased risk for progression to severe ROP (RR: 0.54 [95% CI: 0.35-0.82]).

Conclusions: Among preterm infants with a gestational age of < or = 32 weeks, early low and late high oxygen saturation were associated with a reduced risk for severe ROP. We feel that a large randomized clinical trial with long-term developmental follow-up is warranted to confirm this meta-analytic result.

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Figures

FIGURE 1
FIGURE 1
Association between low oxygen saturation (70%–96%) and risk of severe ROP during the first weeks of preterm life. The test for heterogeneity was not significant (χ2 = 5.41 [degrees of freedom = 4]; P = .248; I2 = 26%). The RR significantly favors low O2 (z = 4.17; P < .001). The size of the marker corresponds to the weight of that study, and error bars represent 95% CIs.
FIGURE 2
FIGURE 2
Association between high oxygen saturation (94%–99%) and risk of severe ROP at a PMA of ≥32 weeks. The test for heterogeneity was significant (χ2 =19.49 [degrees of freedom =4]; P=.001; I2 = 79%). The RR significantly favors high O2 (z = 5.54; P < .001). The size of the marker corresponds to the weight of that study, and error bars represent 95% CIs.
See this image and copyright information in PMC

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