Daily Oxygen Supplementation and Risk of Retinopathy of Prematurity

ABSTRACT

Purpose

Excessive oxygen supplementation increases risk of retinopathy of prematurity (ROP). While numerous oxygen parameters could be considered when predicting ROP (saturation targets, actual saturation, fraction of inspired oxygen, etc.), complicated measures are impractical as screening criteria. We sought to develop a simple, clinically useful measure of daily oxygen supplementation during ages 0–28 days to improve prediction of ROP

Methods

Secondary analysis of two Postnatal Growth and ROP (G-ROP) Study cohorts (G-ROP-1 and G-ROP-2) at 45 hospitals. Infants with a known ROP outcome and complete oxygen data were included. Associations between severe ROP and days on supplemental oxygen (FiO2 > 21%), during ages 0–28 days (DSO28) were assessed, controlling for birth weight (BW) and gestational age (GA). New screening criteria incorporating DSO were developed and compared to current guidelines.

Results

Among 8,949 studied infants, 459 (5.1%) developed type 1 ROP. DSO28 was associated with severe ROP (adjusted-OR 1.05 per day supplemental oxygen, 95%CI 1.03–1.07, p < .0001). The following criteria had 100% sensitivity for type 1 ROP and higher specificity than current guidelines: new BW/GA criteria with DSO (BW<901 g, GA<26 weeks, or DSO >3), 23.4% fewer infants examined; modified G-ROP criteria including DSO, 29.0% fewer infants; original G-ROP criteria, 31.8% fewer infants.

Conclusion

In high-level neonatal-care settings, incorporating DSO (a simple measure of oxygen supplementation) into screening criteria improves sensitivity and specificity for type 1 ROP over current BW-GA criteria, but does not perform as well as the validated G-ROP criteria.

KEYWORDS:

• retinopathy of prematurity
• oxygen
• screening criteria
• risk model
• prediction model
• postnatal growth

Acknowledgments

The G-ROP Study Group investigators include the following: Office of Study Chair: Children’s Hospital of Philadelphia: Gil Binenbaum, MD, MSCE (Principal Investigator), Lauren A. Tomlinson, BS (Project Manager). Data Coordinating Center: University of Pennsylvania Perelman School of Medicine: Gui-shuang Ying, PhD, Maureen G. Maguire, PhD, James Shaffer, MS, Yinxi Yu, MS. Clinical Centers: Emory University School of Medicine (Children’s Healthcare of Atlanta): Amy Hutchinson, MD. University of Colorado Denver (University of Colorado Hospital, Children’s Hospital Colorado): Emily McCourt, MD, Anne Lynch, MD. Albany Medical College: Gerard P. Barry, MD, Marilyn Fisher, MD, MS. Lehigh Valley Hospital: Nachammai Chinnakaruppan, MD, Andrew Meyer, MD. Johns Hopkins University (Johns Hopkins Hospital): Pamela Donohue, ScD, Michael X. Repka, MD. University of Buffalo (Women & Children’s Hospital of Buffalo): James D. Reynolds, MD. Medical University of South Carolina: Edward Cheeseman, MD, MBA. University of Illinois at Chicago: Javaneh Abbasian, MD, Janet Lim, MD. Cincinnati Children’s Hospital Medical Center (Cincinnati Children’s Hospital Medical Center, Good Samaritan Hospital, and University of Cincinnati Medical Center): Michael Yang, MD. Nationwide Children’s Hospital (Nationwide Children’s Hospital, Riverside Methodist Hospital, Grant Medical Center, Doctors Hospital): David Rogers, MD, Rachel E. Reem, MD. Kapi’olani Medical Center for Women and Children: David Young, MD. University of Texas at Houston (Children’s Memorial Hermann Hospital): Megan Geloneck, MD, Robert Feldman MD. Indiana University (Riley Hospital for Children at Indiana University Health): Kathryn Haider, MD, Jingyun Wang, PhD. University of Iowa (University of Iowa Stead Family Children’s Hospital): Edward F. Bell, MD, Alina V. Dumitrescu, MD, Jonathan M. Klein, MD, Gretchen A. Cress, RN, MPH. Queen’s University (Kingston Health Sciences Center): Christine Law, MD. Loma Linda University (Loma Linda University Children’s Hospital): Leila Khazaeni, MD, Jennifer Dunbar, MD (CoI). University of Louisville (Norton Children’s Hospital): Aparna Ramasubramanian, MD, Rahul Bhola, MD. University of Minnesota (Masonic Children’s Hospital, formerly University of Minnesota - Amplatz Children’s Hospital): Jill Anderson, MD, Raymond G. Areaux, Jr., MD. Vanderbilt Eye Institute and Vanderbilt University Medical Center (Monroe Carell Jr. Children’s Hospital at Vanderbilt): David Morrison, MD, Sean Donahue, MD, PhD. University of Oklahoma (The Children’s Hospital at OU Medical Center/The University of Oklahoma Health Sciences Center): R. Michael Siatkowski, MD, Faizah Bhatti, MD. University of Nebraska (Nebraska Medicine): Donny Suh, MD, FAAP, Ann Anderson Berry, MD, PhD. Children’s Hospital of Philadelphia (Children’s Hospital of Philadelphia, Hospital of the University of Pennsylvania, Pennsylvania Hospital): Gil Binenbaum, MD, MSCE, Soraya Abbasi, MD, Haresh Kirpalani, MD, MSc, Graham E. Quinn MD, MSCE, Lauren A. Tomlinson, BS. University of Pittsburgh (Children’s Hospital of Pittsburgh, Magee Women Hospital of UPMC): Christin Sylvester, MD, Kanwal Nischal, MD. Rhode Island Hospital (Women and Infants Hospital of Rhode Island): Wendy S. Chen, MD, PhD. Saint Louis University (Cardinal Glennon Children’s Hospital): Bradley Davitt, MD. University of Utah (Primary Children’s Hospital and University of Utah Hospital): Robert Hoffman, MD, Joanna Beachy, MD, PhD. University of California San Francisco (UCSF Benioff Children’s Hospital and Zuckerberg San Francisco General Hospital, formerly San Francisco General Hospital): Alejandra G. de Alba Campomanes, MD, MPH, Sarah Sitati-Ng’Anda MD. Seattle Children’s Hospital (Seattle Children’s Hospital, University of Washington Medical Center): Kristina Tarczy-Hornoch, MD, D.Phil, Francine Baran, MD. The Hospital for Sick Children (Sick Kids), Toronto: Nasrin Najm-Tehrani, MB BCh, MSc, FRCS Ed (Ophth), FRCSC. Los Angeles Biomedical Research Institute (Harbor-UCLA Medical Center): Monica Ralli Khitri, MD. Crozer-Chester Medical Center (Crozer Chester Medical Center, Delaware County Memorial Hospital): Cynthia Dembofsky, MD, Andrew Meyer, MD. Nemours/Alfred I. duPont Hospital for Children: Dorothy Hendricks, MD, Christopher M. Fecarotta, MD. Cost-Effectiveness Component: Beth Israel Deaconess Medical Center: John Zupancic, MD, MS, ScD.

Disclosure statement

None of the authors have any proprietary interests or conflicts of interest related to this submission.

This paper has not been published anywhere previously and it is not simultaneously being considered for any other publication. This paper has been previously rejected at another journal and did not receive comments for revision.

Author contributions

ME- Conception and design, interpretation of data, drafting and revision of article, final approval

LT- Acquisition and interpretation of data, revision of article, final approval

YY- Analysis and interpretation of data, revision of article, final approval

GY- Design, acquisition, analysis and interpretation of data, drafting article, final approval

GB- Design, acquisition, analysis and interpretation of data, revision of article, final approval

Additional information

Funding

This work was supported by the National Eye Institute [1R01EY021137-01A1, NIH 1R21EY029776-01]. and the Richard Shafritz Chair in Pediatric Ophthalmology Research