Abstract
As increased oxidative stress causes increased mortality and morbidities like bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in very low birth weight infants (VLBWIs), the conundrum of improved survival but increased ROP observed with the high oxygen saturation target range of 91–95% is difficult to explain. To determine the survival rate-dependent variation in ROP treatment rate, 6292 surviving eligible VLBWIs registered in the Korean Neonatal Network were arbitrarily grouped according to the survival rate of infants at 23–24 weeks’ gestation as group I (> 70%, n = 1626), group II (40–70%, n = 2984) and group III (< 40%, n = 1682). Despite significantly higher survival and lower BPD rates in group I than in groups II and III, the ROP treatment rate was higher in group I than in groups II and III. However, the adjusted odds ratios for ROP treatment were not significantly different between the study groups, and the ROP treatment rate in the infants at 23–24 weeks’ gestation was 21-fold higher than the infants at ≥ 27 weeks’ gestation. The controversial association between improved survival and reduced BPD reflecting quality improvement of neonatal intensive care but increased ROP treatment rate might be primarily attributed to the improved survival of the most immature infants.
Highlights
As increased oxidative stress causes increased mortality and morbidities like bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in very low birth weight infants (VLBWIs), the conundrum of improved survival but increased ROP observed with the high oxygen saturation target range of 91–95% is difficult to explain
The overall and gestational age-specific BPD rate in the infants at [25,26] weeks’ gestation and adjusted odds ratios (ORs) for BPD in surviving VLBWIs were significantly lower in group I than in groups II and III, but no significant differences were seen between group II and group III
Clinical characteristics including gestational age and birth weight were significantly lower, and morbidities including BPD and sepsis were significantly higher in surviving VLBWIs with ROP treatment than those without ROP treatment in all three groups
Summary
As increased oxidative stress causes increased mortality and morbidities like bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in very low birth weight infants (VLBWIs), the conundrum of improved survival but increased ROP observed with the high oxygen saturation target range of 91–95% is difficult to explain. Prematurity itself was reported to be a dominant risk factor, with infants born at < 25 weeks’ gestation having 20-fold higher chance of developing severe ROP than those born at 28 weeks’ gestation[11] These findings suggest that the conundrum of association between improved survival reflecting quality improvement of neonatal intensive care and increased ROP treatment rate might be primarily attributed to improved survival of the peri-viable infants born at < 25 weeks’ gestation at the highest risk for developing severe ROP requiring treatment[2,7,21,22]. Gestation at < 40%, 40–70% and > 70%, and stratified according to the presence or absence of BPD and gestational age as [23,24, 25,26] and ≥ 27 weeks’ gestation subgroups in order to determine whether the controversial association between improved survival and reduced BPD reflecting quality improvement of neonatal intensive care but increased ROP treatment might be primarily attributed to survival of the most immature infants at the highest risk of severe ROP requiring treatment
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