Changes in institutional oxygen saturation targets are associated with an increased rate of severe retinopathy of prematurity

Abstract

Purpose: To evaluate the effect of changes in institutional peripheral oxygen saturation (SpO₂) targets, made in response to recent randomized trials, on risk of developing severe retinopathy of prematurity (ROP).

Methods: This study was a secondary analysis of data from 21 North American hospitals during the periods 2006-2012 and 2015-2017. Hospitals were categorized based on whether or not SpO₂ targets were increased between the two study periods. Severe ROP (type 1, type 2, or zone III stage 3+) rates were compared within and between groups. Generalized mixed effect models with random intercepts were used to account for within-center clustering and to calculate odds ratios (aOR) adjusted by birth weight (BW) and gestational age (GA), using patient-level data.

Results: A total of 8,142 infants underwent ROP examinations at 21 hospitals during the two study periods: 5,716 in 2006-2012 (mean BW, 1109 ± 369 g; GA, 28.0 ± 2.6; 11.6% severe ROP); 2,426 in 2015-2017 (mean BW, 1086 ± 347 g; GA, 28.0 ± 2.8; 12.8% severe ROP). Fourteen hospitals increased SpO₂ targets, and 7 hospitals did not. Hospitals that increased targets had a 3% increase in severe ROP (from 12% to 15%; aOR = 1.25; 95% CI, 1.01-1.55; P = 0.044); hospitals without SpO₂ changes had a 2% decrease (from 11% to 9%; aOR = 0.72; 95% CI, 0.52-1.00; P = 0.049). The difference in change of severe ROP between groups of hospitals was significant (P = 0.005).

Conclusions: Increases in institutional SpO₂ targets in response to recent randomized trials were associated with increased severe ROP. Hospitals considering increasing their SpO₂ targets should anticipate increases in rates of severe ROP and manage screening and treatment resources accordingly.