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Randomized Controlled Trial
. 2020 Mar;105(2):138-144.
doi: 10.1136/archdischild-2018-316464. Epub 2019 Jun 22.

Achieved oxygen saturations and retinopathy of prematurity in extreme preterms

Marie G Gantz  1 , Waldemar A Carlo  2 , Neil N Finer  3 , Wade Rich  4 , Roger G Faix  5 , Bradley A Yoder  6 , Michele C Walsh  7 , Nancy S Newman  7 , Abbott Laptook  8 , Kurt Schibler  9   10 , Abhik Das  11 , Rosemary D Higgins  12 ; SUPPORT Study Group of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network
Collaborators, Affiliations
Randomized Controlled Trial

Achieved oxygen saturations and retinopathy of prematurity in extreme preterms

Marie G Gantz et al. Arch Dis Child Fetal Neonatal Ed. 2020 Mar.

Abstract

Objective: To identify achieved oxygen saturations (SpO2) associated with increased risk of severe retinopathy of prematurity (ROP).

Design: This is a secondary analysis of the Surfactant Positive Airway Pressure and Pulse Oximetry Trial (SUPPORT)randomised controlled trial. SpO2 was recorded up to 36 weeks' postmenstrual age. Saturations through 9 postnatal weeks were explored graphically, and logistic regression models were created to predict severe ROP.

Setting: 20 centres of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network.

Patients: 984 surviving infants of 24-27 weeks' gestational age born in 2005-2009.

Interventions: SUPPORT targeted SpO2 to a lower (85%-89%) or higher (91%-95%) range through 36 weeks' postmenstrual age or off respiratory support.

Main outcome measures: Severe ROP defined as threshold ROP, ophthalmological surgery or bevacizumab treatment.

Results: There were statistically significant interactions between duration of oxygen supplementation and percentage of time in certain achieved saturation ranges. Specifically, for infants who spent at least 2 weeks on oxygen in postnatal weeks 1-5, a higher percentage of time at 91%-96% SpO2 was associated with increased odds of severe ROP. For infants who spent at least 3 weeks on oxygen in postnatal weeks 6-9, a higher percentage of time at 97%-100% SpO2 was associated with increased odds of severe ROP. Other significant risk factors were lower gestational age and birth weight, non-Hispanic white versus black race, prospectively defined severe illness, late-onset sepsis or meningitis, and clinical centre.

Conclusions: Among extremely preterm survivors to discharge, the association between SpO2 and severe ROP depended on the timing and duration of oxygen supplementation.

Keywords: neonatology; ophthalmology; respiratory.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1.
Figure 1.
Survival curve for probability of oxygen supplementation through 12 postnatal weeks, by severe ROP.
Figure 2.
Figure 2.
Total hours per week each infant spent at each oxygen saturation value during time on supplemental oxygen in postnatal weeks 1–5 and 6–9, by severe ROP.
Figure 3.
Figure 3.
Total hours with saturations of 97–100% for each infant during time on supplemental oxygen, by postnatal week and severe ROP.
Figure 4.
Figure 4.
Results of logistic regression model to predict severe ROP. Adjusted odds ratios (OR) and 95% confidence intervals (CI) are shown for the effect of percentage of time on oxygen with saturations of 91–96% during postnatal weeks 1–5, and percentage of time on oxygen with saturations of 97–100% during postnatal weeks 6–9. Because there were significant interactions in the logistic regression model, ORs and CIs for the effect of the percentage of time spent in the saturation ranges are presented separately for infants spending 1, 2, 3, 4, or 5 weeks on supplemental oxygen during the specified postnatal time period.
See this image and copyright information in PMC

References

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