Increased risk of retinopathy of prematurity since increased O2 saturation targets: A multi‐centre study

Abstract

Background/AimsRetinopathy of prematurity (ROP) is a leading cause of visual impairment in premature neonates. The BOOST II, SUPPORT and COT trials recommended increasing O2 saturation targets for pre‐term neonates to reduce mortality; however, this is a risk factor for ROP. We aimed to determine whether these targets increased prevalence of ROP among pre‐term neonates and higher risk groups.MethodsRetrospective cohort study conducted using data from the Australian and New Zealand Neonatal Network. 17 298 neonate cohort born 2012–2018 at <32 weeks' GA and/or <1500 g BW was analysed. Adjusted odds ratios (aORs) were calculated for post‐2015 risk of: any ROP; ROP ≥ Stage 2; and treated ROP. Sub‐analysis stratified at <28 GA, < 26 weeks' GA, <1500 g BW and <1000 g BW was performed.ResultsRisk of any ROP increased in the post‐2015 group (aOR = 1.23, 95% confidence interval (CI) = 1.14–1.32), <28 weeks' GA (aOR = 1.31, 95% CI = 1.17–1.46), <26 weeks (aOR = 1.57, 95% CI = 1.28–1.91), <1500 g (aOR = 1.24, 95% CI = 1.14–1.34) and <1000 g (aOR = 1.34, 95% CI = 1.20–1.50). ROP ≥ Stage 2 increased at <28 weeks (aOR = 1.30, 95% CI = 1.16–1.46), <26 weeks (aOR = 1.57, 95% CI = 1.28–1.91), <1500 g (aOR = 1.18, 95% CI = 1.08–1.30), and <1000 g (aOR = 1.26, 95% CI = 1.13–1.42).ConclusionO2 therapy guidelines since 2015 have resulted in decreased mortality but increased risk of ROP. Individualised NICU adjustments of ROP screening/follow‐up methods are necessary to address the clinical burden.