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

Abstract

To study characteristics of oxygenation during the first 2 postnatal months and correlation with the occurrence and severity of retinopathy of prematurity (ROP) among infants of extremely low birth weight. This retrospective study analyzed the incidence and severity of hyperoxemia and hypoxemia while on respiratory support with or without supplemental oxygen among infants of extremely low birth weight (birth weight <1000g) admitted to the neonatal intensive care unit during 2016-2020. The findings were correlated with the occurrence and severity of ROP after adjusting for baseline covariates. After adjusting for differences in baseline demographic and clinical features, the group with severe ROP was exposed to greater fraction of inspired oxygen (FiO2) (P=.001) and experienced more frequent FiO2 titration adjustments (P=.001) compared with the group without ROP. Ambient air hyperoxemia occurred more frequently in the group without ROP (P=.003), and iatrogenic hyperoxemia occurred more frequently in the group with severe ROP (P=.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=.01) and longer time spent in the severe hypoxemic range (P=.005) compared with the group without ROP. Severe ROP is associated with greater FiO2 exposure, increased iatrogenic hyperoxemia, decreased ambient air hyperoxemia, and increased hypoxemia in infants of extremely low birth weight despite a greater 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.