Oxygenation Factors Associated with Retinopathy of Prematurity in Infants of Extremely Low Birth Weight

Objective

To study characteristics of oxygenation during the first two postnatal months and correlation with the occurrence and severity of retinopathy of prematurity (ROP) among extremely low birth weight infants.

Study design

This retrospective study analyzed the incidence and severity of hyperoxemia and hypoxemia while on respiratory support with or without supplemental oxygen among extremely low birth weight (ELBW, birth weight<1000 grams) infants admitted to the NICU during 2016- 2020. The findings were correlated with the occurrence and severity of ROP after adjusting for baseline covariates.

Results

After adjusting for differences in baseline demographic and clinical features, the group with severe ROP was exposed to higher FiO₂ (p=0.001) and experienced more frequent FiO₂ titration adjustments (p=0.001) compared with the group without ROP. Ambient air hyperoxemia occurred more frequently in the group without ROP. (p=0.003) and iatrogenic hyperoxemia occurred more frequently in the group with severe ROP (p=0.046). There were no differences in the severity of ambient and iatrogenic hyperoxemia in the study population. The group with severe ROP demonstrated more hypoxemic episodes (p=0.01) and longer time spent in the severe hypoxemic range (p=0.005) compared with the group without ROP.

Conclusions

Severe ROP is associated with higher FiO₂ exposure, increased iatrogenic hyperoxemia, decreased ambient air hyperoxemia and increased hypoxemia in extremely low birthweight infants despite a higher frequency of FiO₂ titration. This study illustrates the need for automated closed loop FiO₂ delivery systems to further optimize oxygen saturation targeting in this high-risk population.