Impact of changing oxygenation policies on retinopathy of prematurity in a neonatal unit in Argentina


Urrets-Zavalia, JA; Crim, N; Knoll, EG; Esposito, FA; Collino, E; Urrets-Zavalia, ME; Saenz-de-Tejada, G; Torrealday, JI; Serra, HM; Gilbert, C; (2012) Impact of changing oxygenation policies on retinopathy of prematurity in a neonatal unit in Argentina. The British journal of ophthalmology, 96 (12). pp. 1456-1461. ISSN 0007-1161 DOI: https://doi.org/10.1136/bjophthalmol-2011-301394

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Abstract

Aims To assess the impact of different oxygenation policies on the rate and severity of retinopathy of prematurity (ROP). Methods Between January 2003 and December 2006, infants of 1500 g birthweight (BW) or less and/or 32 weeks gestational age (GA) or less, and larger, more mature infants with risk factors for ROP were examined through three different time periods: period 1: high target oxygen saturation levels (88-96%) and treatment at threshold ROP; period 2: low target oxygen saturation levels (83-93%) and treatment at threshold ROP; period 3: low target oxygen saturation and treatment at type 1 ROP. Results Type 1 ROP was detected more frequently in babies of 32 weeks GA or less (50/365, 13.7%) than in more mature babies (15/1167, 1.3%; p<0.001). The rate of type 1 ROP in period 1 was 6.9%; period 2, 3.6% and period 3, 1.8%. Rates of stage 3 ROP declined over time in both BW/GA groups (from 9.0% to 4.1% to 2.0%) as did rates of plus disease (from 7.5% to 3.6% to 1.8%). Mean BW and GA declined from period 1 to period 3, and death rates remained unchanged. 74.4% of babies received all the examinations required; 48.1% of treatments were undertaken after discharge from the neonatal unit. Conclusions Lower target oxygen saturation was associated with a lower rate of severe ROP without increasing mortality, and changed the characteristics of affected babies. Screening criteria need to remain wide enough to identify all babies at risk of ROP needing treatment.

Item Type: Article
Keywords: Argentina, epidemiology, Follow-Up Studies, Gestational Age, Humans, Infant, Infant, Newborn, Infant, Premature, Infant, Very Low Birth Weight, Intensive Care Units, Neonatal, Oxygen Consumption, physiology, Oxygen Inhalation Therapy, standards, Practice Guidelines as Topic, Retinopathy of Prematurity, metabolism, mortality, therapy, Retrospective Studies, Risk Factors, Survival Rate, trends
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Research Centre: The International Centre for Evidence in Disability
International Centre for Eye Health
Centre for Maternal, Reproductive and Child Health (MARCH)
Centre for Global Non-Communicable Diseases (NCDs)
PubMed ID: 23038764
Web of Science ID: 311422600003
URI: http://researchonline.lshtm.ac.uk/id/eprint/612076

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